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The Authorization Specialist is primarily responsible for ensuring a positive patient experience by verifying patient eligibility and initiating necessary prior authorizations using online resources and direct communication with insurance providers. This role also involves reviewing medical records, updating information in the EMR system, and coordinating peer-to-peer meetings for physicians.
Requirements summary
Candidates must be able to interpret specified records and possess knowledge of Medical and Diagnosis codes (CPT/DX), along with demonstrated understanding of medical terminology and insurance operating procedures. Required qualifications include a High School diploma or equivalent and 1-3 years of work experience within a healthcare environment.
high schoolProblem SolvingPrioritizationElectronic Medical Record (EMR)Medical TerminologyMicrosoft Office SuiteDiscretionPrior AuthorizationsMedical Records ReviewDemographic Information UpdateInsurance Company CommunicationBenefit InvestigationPatient Eligibility CheckingPeer to Peer CoordinationInsurance Denials and AppealsMedical Coding (CPT/DX)Third-Party Operating Procedures
Job description
Our Authorization Specialist will be responsible for providing a great patient experience by checking patient eligibility and initiating prior authorizations. This includes utilizing online resources, reviewing medical records, calling insurance companies, and completing authorization forms in our Electronic Medical Record system.
What this role entails
Check patient eligibility and insurance plan benefits via online payer portals and confirming with insurance companies
Scan complete authorization form in EMR system
Review medical records
Initiate authorizations using online resources, insurance specific forms, and making outgoing calls to insurance companies
Follow department procedures to ensure timely completion of benefit investigations
Communicate with internal patient financial services department, clinical staff and external practice managers when inaccurate demographic information is supplied
Review and update authorization information in the EMR system
Support and actively participate in initiatives designed to improve individual and organizational performance.
Coordinate with clinical staff to set up peer to peer meetings for physicians and insurance medical directors.
Assist patients with insurance denials and appeals
Performs other duties/special projects and tasks as assigned
What you offer
Able to read, interpret, and implement specified records.
Knowlege of Medical and Diagnosis codes (CPT/DX)
Demonstrated knowledge of medical terminology and office procedures.
Demonstrated knowledge of third-party and insurance company operating procedures, regulations and billing requirements.
Experience with Microsoft Office suite and Electronic Medical Record (EMR) system.
Ability to effectively establish and maintain cooperative and effective working relationships
Effectively prioritize competing responsibilities, with a sensitivity toward matters which are time sensitive.
Exercise a high level of discretion and sensitivity to patient privacy.
Benefits
Dental Insurance
Employee Assistance Program
Life Insurance
Paid Parental Leave
Paid Time Off
Health Insurance
Vision Insurance
Health Savings Account
Employee Referral Program
Long-term Disability Insurance
401(k) Plan
Adoption Assistance
Lifestyle Spending Account
Fertility Benefits
Continuing Education Reimbursement
Surrogacy Support
Calm Health Subscription
Ability to recognize, evaluate, solve problems and correct errors.
Ability to use telephone, keyboard, computer, office equipment and software programs.
Education and Experience
High School diploma or equivalent required
1-3 years’ work experience in a healthcare environment required
Why You'll Love Working Here – Our Amazing Benefits
Comprehensive Health Coverage
Medical, dental, and vision plans for our full-time employees, along with complimentary basic life insurance, Employee Assistance Program, and long-term disability insurance. FREE or low-cost employee-only healthcare coverage option is also available.
Family Building Support
Take advantage of our comprehensive fertility benefits, adoption assistance, and surrogacy support to help grow your family.
Paid Parental Leave
Generous maternity, paternity, and partner leave so you can focus on what matters most.
Plenty of Paid Time Off
Start with 18 days of PTO annually and enjoy 11 paid holidays, including one floating holiday to use as you choose!
Retirement Ready
Invest in your future with our 401(k) plan, featuring a competitive company match and full vesting after just 2 years.
Lifestyle Spending Account
Access a company-funded account to reimburse expenses that boost your physical, financial, and emotional well-being.
Health Savings Account (HSA)
If eligible, enjoy regular employer contributions to your HSA with every paycheck.
Rewards for Connections
Earn extra money with our Employee Referral Program—your network is invaluable!
Growth Opportunities
We support your career with continuing education reimbursement and dedicated time off for professional development.
Premium Calm Health Subscription
Enjoy a free premium Calm Health app subscription to support your mental wellness.
Emotional & Work-Life Support
Through our Employee Assistance Program (EAP) with SupportLinc, you'll have access to emotional well-being and work-life resources whenever you need them.
Extra Peace of Mind
Explore additional coverage options including Accident, Critical Illness, Hospital Indemnity, and Pet Insurance, to suit your needs.
