Authorization Specialist

The Insurance Authorization Specialist is a member of the Finance and Billing Department who is responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary services. This individual determines which patient services have third party payer requirements and is responsible for obtaining the necessary authorizations for procedures and medical exams. The Authorization Specialist provides detailed and timely communication to both payers and clinical partners in order to facilitate compliance with payer contractual requirements and is responsible for documenting the appropriate information in the patient's record and will perform all the other duties as assigned.

JOB REQUIREMENTS

Minimum of two years' experience in hospital billing/pre-authorization or insurance verification with demonstrated knowledge of health insurance plans including: Medicare, Medicaid, HMO's and PPO's required. Prior experience in a business office position with strong customer service background preferred. Education High School Diploma with relevant experience could be considered, A.S. degree preferred. Special Skills Exceptional customer relations skills required. Knowledge of online insurance eligibility systems. Proficient in Microsoft Excel, Word and Acrobat skills. Familiarity with Medical Terminology. Demonstrated ability to efficiently organize work and maintain a high level of accuracy and productivity.

JOB STANDARDS

Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt. Successfully works with payers via electronic/telephonic and/or fax communications. Responsible for verification and investigation of pre-certification, authorization, and referral requirements for services. Coordinates and supplies information to the review organization (payer) including medical information and/or letter of medical necessity for determination of benefits. Collaborates with designated clinical contacts regarding encounters that require escalation to peer-to-peer review. Communicates with patients, clinical partners, financial counselors, and others as necessary to facilitate authorization process. Facilitates submission of clean claims and reduction in payer denials by adhering to both organizational and departmental policies and procedures and maintaining departmental productivity and quality goals. Appropriately prioritizes workload to ensure the most urgent cases are handled in a timely manner. Completes accurate documentation in both the Auth/Cert and Referral Shells. Completes notification to all payers via electronic/fax/telephonic means within 24 business hours of service to ensure compliance with Managed Care contractual requirements. Determines Medicare primacy based on Federal guidelines. Determines inpatient Medicare coverage for days exhausted and hospice entitlement. Ensures timely and accurate insurance authorizations are in place prior to services being rendered. Follows departmental policies and procedures when necessary authorization is not obtained prior to service date. Answers provider, staff, and patient questions surrounding insurance authorization requirements.

Job Type:

Full-time Pay:

$22.00 - $30.00 per hour

Benefits:

401(k) 401(k) matching Dental insurance Health insurance Paid time off Vision insurance

Schedule:

Monday to Friday Ability to commute/relocate: San Jose, CA 95128: Reliably commute or planning to relocate before starting work (Required)

Experience:

Insurance verification: 3 years (Required) Medical billing: 1 year (Preferred)

Work Location:

In person

Job Type:

Full-time Pay:

$25.45 - $30.83 per hour Expected hours: 40 per week Ability to

Relocate:

San Jose, CA 95128: Relocate before starting work (Required)

Work Location:

In person