JOB TITLE: Insurance Authorization Specialist (must be bilingual English/Spanish!)

GENERAL SUMMARY OF DUTIES:

Responsible for obtaining managed care authorizations and verifying patient insurance benefits. Analyzing utilization data from health plans' claims as required. Maintains optimal patient, referring physician and insurance company satisfaction.

SUPERVISION RECEIVED: Front Office Manager

ESSENTIAL FUNCTIONS:

• Obtaining required referrals and authorizations prior to services via phone, fax, on-line, etc.
• Review office schedules daily for patients requiring authorizations, referrals, pre-notification, and insurance eligibility verification.
• Obtaining retro-authorizations or updating existing authorizations in a timely manner.
• Inputting/updating authorization information into EHR.
• Updates the patient account with details of the insurance verification.
• Identifies deductibles, co-pays, and self-pay accounts. Identifies large dollar DME accounts.
• Notifying the appropriate staff members if treatment or service is denied.
• Coordinating with the Financial Counselor necessary information for patient discussions.
• Working with the provider if a peer-to-peer review is necessary or requested by the payer.
• Keeping up-to-date on third party payer authorization requirement information.
• Re-verify all patients monthly for active, current insurance.
• Assist Collection staff with account questions when presented.
• Participates in professional development efforts to ensure currency in health care practices and trends.
• Perform other duties as assigned.

EDUCATION: High School, with 1-2 years experience in healthcare insurance billing and verification, collections and/or authorizations.

KNOWLEDGE:

• Knowledge of clinic policies and procedures.
• Knowledge of managed care contracts and utilization.
• Knowledge of computer systems, programs and spreadsheet applications.
• Knowledge of medical terminology.
• Knowledge of CPT/ICD-9

SKILLS:

• Skill in gathering and reporting claim information.
• Skill in solving utilization problems.
• Skill in written and verbal communication and customer relations.

ABILITIES:

• Ability to work with effectively with medical staff and external agencies.
• Ability to identify, analyze and solve claim problems.

PHYSICAL/MENTAL DEMANDS:

Requires sitting and standing associated with a normal office environment.

ENVIRONMENTAL/WORKING CONDITIONS:

Normal busy office environment with much telephone work. Occasional evening or weekend work.

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.

Detail Oriented - Capable of carrying out a given task with all details necessary to get the task done well
Team Player - Works well as a member of a group

Ability to Make an Impact - Inspired to perform well by the ability to contribute to the success of a project or the organization
Self-Starter - Inspired to perform without outside help

Bachelors (preferred)

3 - 5 years: Medical Authorization Experience (preferred)
3 - 5 years: Medical office Experience (preferred)