A Multi-Specialty Medical Center is seeking individuals with experience for the Authorization Department at multiple levels. Responsibilities include and not limited to insurance verification, pre-certification, and authorization and/or referral. This position will be located in our Midwood Brooklyn location.
The Authorization-Referrals Specialist is responsible for verifying insurance policy benefit information, and securing payer required referrals and authorizations. This position is responsible for obtaining accurate and timely pre-authorizations for professional services prior to the patient’s visit, scheduled procedure or service. Prior authorizations may include, but are not limited to outpatient treatments, medications and diagnostic testing (i.e. ultrasounds, labs, radiology, pharmacy physical therapy and referrals)
Job Responsibilities:
- Verifies insurance coverage via system tools, payer portals (Electronic Query (Real-Time-Eligibility [RTE]/Insurance Payer Portal/Phone).
- Upon verification of patient's insurance coverage, update changes in the billing system.
- Confirms provider’s participation status with patient’s insurance plan/network.
- Determines payer referral and authorization requirements for professional services.
- Contacts patient and PCP to secure payer required referral for planned services.
- Documents referral in practice management system.
- Researches system notes to obtain missing or corrected insurance or demographic information.
- Reviews clinical documentation to insure criteria for procedure meets insurance requirements.
- Initiates authorization and submits clinical documentation as requested by insurance companies.
- Follows through on pre-certifications until final approval is obtained.
- Manage faxes, emails, and phone calls in a timely manner. Responds to voicemails and emails within same business day of receipt.
- Communicates with surgical coordinators regarding authorizations status or denials.
- Submits appeals in the event of denial of prior authorizations or denial of payment following procedures.
- Set up peer to peer calls with clinical providers and insurance companies, as needed.
- Calculate and document patient out of pocket estimates and provide to patient.
- Responsible for being a specialist in the area of payer policy authorizations for internal and external customer inquiries.
- Meet daily/weekly/monthly/annual departmental productivity goals and targets are required.
- Conforms to all applicable HIPAA, Billing Compliance and safety policies and guidelines.
- Serves as primary liaison between faculty practice/department, insurance companies and patient to verify eligibility and coordination of benefits and resolve any insurance complications.
- Performs other job duties as assigned, including but not limited to, job functions in the area of insurance verification unit.
Minimum Requirements - High School Graduate or GED Certificate. - Good interpersonal, verbal, telephone and written communication skills in the English language. - Functional knowledge of basic computer operation and keyboard functions.
- Ability to follow-through and handle multiple tasks simultaneously.
- Ability to work independently and be team player.
- Must be a positive individual with a positive attitude and exceptional work ethic.
Preferred: - Minimum of 1-2 years of healthcare customer service experience (depending on the level of position (I, II or III). - Knowledge if Medical Terminology, Diagnosis and Procedure coding.
Knowledge of diagnostics authorization for Cardiology and Radiology
- Applications- eClinicalWorks EMR/PM
Job Types: Full-time, Part-time
Pay: $20.00 - $25.00 per hour
Expected hours: 24 – 40 per week
Benefits:
- 401(k)
- 401(k) matching
- Paid time off
Weekly day range:
Experience:
- Prior-Authorization: 3 years (Required)
Work Location: In person