Insurance Authorization Specialist

Department: Billing

Days: Monday to Friday

Hours: 8am to 5pm

Job Summary: Obtains authorizations for surgical procedures and offsite diagnostic imaging. Creates medical and dental surgical estimates.

Education and Experience Requirements:

• High school degree or equivalent
• Degree and/or training in medical billing and coding
• Minimum of three years in the health care field
• Strong background and experience in understanding patient accounts as to private pay, health insurance, billing, and collection processes.

• Strong interpersonal skills. The ability to relate effectively with physicians and staff, as well as outside business associates at multiple levels.
• Computer literate and knowledge of practice management software, insurance, and billing software. Epic knowledge preferred.
• Use of appropriate e-mail and internet practice applications.
• Basic knowledge of insurance pre-authorization process.
• Understanding of Managed Care contractual policies.
• Knowledge of CPT and ICD-10-CM coding; otolaryngology and oral maxillofacial surgery preferred.

Responsibilities include, but are not limited to, the following:

• Ensures insurance carrier documentation requirements are met for pre-authorizations as it pertains to procedural and/or surgery needs.
• Initiates expedited reviews with payers when necessary to ensure authorization is in place prior to, or at the time of service, and communicates late notifications or risk of no auth situation to Surgery Schedulers as soon as identified.
• Researches and develops resources that create timely and efficient workflow.
• Routinely monitors cases pending or not yet started/complete, being attentive to payer specific processing time.
• Maintains excellent communication and positive rapport with all points of contact both internally and externally. Documents pertinent discussions and details of correspondence in all applicable systems to provide tracking and point of reference.
• Properly handle denied authorization cases and seek resolution through involved parties.
• Create medical and dental surgical estimates based on health insurance coverage.
• Attend all billing department and staff meetings.

Typical Physical Demands:

Work may require sitting for long periods of time, stooping, bending, and stretching. This position requires manual dexterity sufficient to operate a keyboard, computer, telephone, calculator, copier, and such other office equipment, as necessary. Employee must have normal range of hearing and eyesight. Position also requires viewing computer screens and typing for long periods of time and working in a fast-paced environment.

Typical Working Conditions:

Work is performed in a billing area and involves frequent contact with patients, insurance carriers and physicians. Work may be stressful at times.