JOB SUMMARY

The Authorization Specialist is responsible for the day-to-day processes to verify patient eligibility and obtain authorization for all exams scheduled to ensure timely payments from all accepted payer. The typical daily work load consists of the following: eligibility investigations via phone and online web portals, obtaining authorizations, collecting supporting clinical data from patients and/or referring offices and updating all information.

RESPONSIBILITIES

Manage the predetermination, authorization, and referral requirements of each health plan and meeting the requirements prior to the delivery of services. Contacts patients and/or referring offices for updated insurance information, medical records and/or additional clinical data to ensure that no more than 5% of all exams end up in pending clinical. Cross reference daily schedule and work queue to ensure that all scheduled exams are authorized forty-eight (48) hours prior to the date of service. Cross reference daily schedule and work queue to ensure that all same day add-ons are authorized prior to the completion of the exam; other payers must be authorized within twenty-four (24) hours following the completion of the exam. Work with each health plan to provide medical records and/or additional clinical data to ensure that 99% of all completed exams are approved for payment. Communicate and coordinate effectively with internal departments to ensure patient insurance information is accurate and updated.

LINE OF AUTHORITY

Reports to the Administrative Director Employee

QUALIFICATIONS

Current knowledge of medical terminology, insurance authorization and verification. Knowledge of ICD-Codes/CPT preferred. Strong technical skills (Word, Excel, Acrobat or similar product). Successful completion of or the ability to successfully complete any state required continuing education requirements. Excellent verbal and written communication skills and strong interpersonal skills. Ability to work in a fast paced setting. Knowledge of regulatory requirements at the federal, state and local levels, as well as knowledge of Agency policies and procedures. At least 21 years of age.