- Contact insurance carriers to verify patient's insurance eligibility, benefits and requirements.
- Request, track, follow up and obtain prior authorization status from Insurance Prior Authorization Specialist.
- Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
- Communicate any insurance changes or trends among team.
- Maintains a level of productivity suitable for the department.
- Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.
- Other duties as assigned
- High School diploma or equivalent.
- Minimum three (3) to seven (7) years of experience in medical and pharmacy prior authorization claims.
- Previous experience in a clinic setting preferred
- Familiarity with Cover My Meds and Availity
- Collects and reviews all patient insurance information and submits prior-authorization form.
- Authorization Specialist are responsible for all aspects of benefit verification and authorization.
- Authorization Specialists ensure that clients meet patients' insurance requirements for reimbursement prior to testing or treatment.
- Obtains necessary pre-authorizations from payer.
- Communicates with physician/clinical staff any pre-certification or PA requirements by the patient's insurance carriers.
- Ensures up-to-date documentation on patient's account in Electronic Medical Record related to authorization approvals and denials.
- Maintains updated referrals and authorizations.
- Communicates with ordering physician practice for denials that will require appeals, rescheduling, and/or peer-to-peer review by the ordering physician.
- Follows policy and procedures outlined by management to ensure standardization of processes across the organization.
- At least three years of previous experience in performing prior authorizations is required (Duplicate preference with above)
- Knowledge of insurance and third party payers.
- Basic computer knowledge and keyboarding skills including Microsoft Office and Excel
- Excellent communication skills.
- Customer service experience.
- Strong organizational skills.
- Detail-oriented.
- Ability to multi-task and work well in a fast-paced setting.
- Critical thinking skills and decisive judgment.
- Knowledge of medical terminology.
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Authorization Specialist - Keller, United States - Vital Care Infusion Services
2 weeks ago
Description
Job Description
Job DescriptionESSENTIAL DUTIES AND RESPONSIBILITIES :
Qualifications:
The ideal candidate for the Authorization Specialist position will have the following background and experience:
KNOWLEDGE /SKILLS REQUIRED TO BE SUCCESSFUL IN THIS POSITION:
