What are the responsibilities and job description for the Authorization Specialist position at WMC Health?
Job Details : Job Summary :
The Authorization Specialist is responsible for performing complex clerical procedures related to verifying insurance information and obtaining authorization for hospital procedures and tests as well as office diagnostic testing in accordance with established rules and procedures, specified time frames and regulatory requirements. The employee processes clinical information in a timely, efficient manner to prevent treatment delays and to avoid denials from third-party payers and maintain the confidentiality of patient information.
Responsibilities :
- Serves as liaison between physicians, office staff, patients and insurance carriers regarding the authorization process.
- Collects and reviews for accuracy patient demographic and insurance data as part of the authorization process.
- Collects and submits all documentation and diagnosis needed for authorization.
- Advises physicians, surgical coordinators practice administration of problems with insurance authorizations and resubmits requests with additional or revised information as needed.
- Notifies the provider of the need for peer-to-peer reviews for problem cases which have been initially denied authorization for services and will assist with the arrangement of the same.
- Provides daily follow-up with the authorization departments of the various insurance carriers for an update of the status of the various authorization requests to ensure optimum delivery of services.
- Adheres to the policy to prevent denials or patient delays
- Performs eligibility checks on insurance payers internet websites and RTE
- Effectively utilize automated systems to perform work assignments
- Continually reviews diagnostic testing schedules at multiple locations to capture any changes, i.e., add on testing to the various schedules.
- Reviews daily what authorizations for procedures have processed and what is outstanding.
- Logs in deliveries of medications received from specialty pharmacies on a daily basis and notifies the appropriate person via EMR and in person.
- Performs other tasks as assigned
Qualifications / Requirements :
Experience :
1-3 years of experience in the healthcare field is required. Previous experience with the pre-authorization process preferred. Experience in the field of ENT, preferred
Education :
A high school diploma or equivalency required.
Licenses / Certifications :
N / A
About Us :
NorthEast Provider Solutions Inc.
Benefits :
We offer a comprehensive compensation and benefits package that includes :
