Insurance Authorization Specialist Jobs

Connect with patients pharmacy benefit plans when treatment is not covered through medical benefits

Minimum two years of relevant experience.

Medical, Dental, Vision, and Life Insurance

Discounted tuition on selected universities/colleges

Act as a liaison between the Precert Team and the office/patients for all infusion treatment authorizations

Respond and reply to emails with the Precert Team on a daily basis

Coordinates with Care Management for level of care, Medicare Inpatient Only list, and required authorizations.

Communicates and promptly escalates accounts of concern to management.

High School Diploma or equivalent combination of education and experience.

Other duties as assigned by manager.

Experienced in processing financial clearance for complex services including surgical services, observation, and in-house cases.

National certification in HFMA CRCR and/or NAHAM CHAA within one (1) year of hire.

Experience with I-9 Service center/case management system.

Excellent organizational skills, prioritizing, and multi-tasking abilities.

Requires 3+ years of directly related experience.

Strong leadership, communication, and interpersonal skills.

Prioritizes and independently executes responsibilities.

Experience in a large or matrix driven corporation with overseas or outsourced operations.

Skills Preferred: Understanding of authorization processes, insurance regulations, third party payors, and reimbursement practices; Experience utilizing a web-based computerized system.

Research denials by interpreting the explanation of benefits or remittance codes and prepares appeals for underpaid, unjustly recoded, or denied claims.

Submit requests for account adjustments/controllable losses to manager in accordance with departmental process.

Identify authorization related edit/denial trends and causative factors, collates data, and provides summary of observations. Communicate identified trends to Manager.

Completion of a medical terminology course (or equivalent) or has 3 years of experience working with medical field required.

Maintain compliance with departmental quality standards and productivity measures.

Knowledge of Medicaid, insurance verification, and authorization management

Stays up to date with education on Authorization requirements

One (1) - two (2) years experience in data entry, record keeping, or similar experience in the healthcare field

Career growth and experience with an industry leader with 40+ years of history in a high-demand field

Manage all NOAs for Waiver and DD clients and enter authorizations into Matrixcare.

Alerts the Branch Manager regarding late or missing documents required for billing.

Basic Education and/or Experience Requirements

Processes benefit verification or authorization for all new referrals with speed and accuracy.

Assist AVA Supervisor and Manager with special assignments as needed.

Minimum of two years of experience in related experience.

Does this position have supervisory responsibilities? NO

High school diploma or equivalent is required.

Assists with the identification and reporting of quality management and non-coverage issues.

Requires in depth knowledge of benefits and authorizations

Verifies eligibility of members and members benefit coverage.

Responsible that all discrepancies are reported to the Director of Finance.

Performs all other duties assigned by Director of Finance.

High School Education - *Associates Degree preferred

Proficient in relevant computer applications, data entry, and typing skills

Associates Degree or 4-5 years relevant work experience

Knowledge of customer service practices and principles

Proficient listening, verbal, and written communication skills

Performs all essential job functions of Tissue Donation Coordinators

Approach families by telephone regarding their options to donate

Coordinate, review, and analyze documentation and data entry supporting Medicare, Medicaid, and commercial payer requirements to ensure accurate and timely billing

Ensure all internal controls and related policies/procedures are implemented and followed in accordance to the accounts receivable requirements.

Ensure all payer requirements are met accordingly, including pre-cert requirements, notification requirements, and level of care change required documents.

Assist with training of newly-hired associates, as well as re-education of revenue teams as necessary.

One to two years related experience and/or training preferred.

Two years Home Health care or Medical Office experience preferred.

Utilizes electronic scheduling/registration/financial systems, payers websites, and recorded calls to validate health coverage and benefits in processing approval for medical services.

Works closely with Managed Care and understands health insurances rule sets, manuals, and contract language.

Computer skills appropriate to position

Written and verbal communication skills

: Yes - CMS Requirements Apply

Maintains proper documentation in Soarian or GE systems.

Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements

Advanced knowledge of medical coding and billing systems, documentation, and regulatory requirements

Knowledge of current and developing issues and trends in medical coding procedures requirements

Identify the appropriate clinical records and submit the authorization request to the insurance company based on plan requirements for approval.

Knowledge of appeals concepts and principles

Ability to use independent judgement and to manage and impart confidential information

Processes benefit verification or authorization for all new referrals with speed and accuracy.

Assist AVA Supervisor and Manager with special assignments as needed.

Minimum of two years of experience in related experience.

High school diploma or equivalent is required.

Ability to multi-task and support numerous referrals/priorities at one time.

Ability to work in a fast past environment.

Experienced with a knowledge of Availity, MyNexus, Zirmed, Ability, and other common clearinghouses.

Analytical thinkers with strong written and verbal communication skills.

1+ year experience directly completing insurance verifications and requesting authorizations.

Home health/hospice experience is preferred.

Perform routine review of appropriate workflows and redirect workflows as needed.

Demonstrate ability to solve problems independently and at an optimal level.

Processes benefit verification or authorization for all new referrals with speed and accuracy.

Assist AVA Supervisor and Manager with special assignments as needed.

Minimum of two years of experience in related experience.

High school diploma or equivalent is required.

Ability to multi-task and support numerous referrals/priorities at one time.

Ability to work in a fast past environment.

Manage referral and authorizations information as assigned

0-2 years of relevant work experience, including healthcare/business administration, health insurance, medical policy/chart review, nursing, and/or other allied health fields

Strong Microsoft Office Suite experience

Experience with Epic is a plus

Perform pre-registration of new patients by making/receiving patient calls collecting and documenting patient demographics, financial, and other relevant personal information

Update changes to patient insurance and/or demographic information as needed

Manage prior authorization process from initial submission to authorization

0-2 years of relevant work experience, including healthcare/business administration, health insurance, medical policy/chart review, nursing, and/or other allied health fields

Strong Microsoft Office suite experience

Review and monitor all radiology authorization imaging exams

Identify all patient access issues creating barriers to prior authorization

Prepare and complete prior authorization request

Case Management, Utilization Review or Prior Authorization experience

Minimum of 2 year of clinical and/or related experience

Shows strong analytical and problem-solving skills.

Superior written and verbal communication skills

Knowledge of third-party payer rules and regulations

High School Diploma or equivalent

2+ years of recent prior authorization experience required

Explain financial policy to patients and discuss financial responsibilities including copays, coinsurances, deductibles and time of service payments

Ensure physician documentation supports payer requirements for authorization processing

Schedule PET and Nuclear appointments after reviewing financial responsibilities with patient

Required Qualifications Of The Authorization Specialist II

Responsibilities Of The Authorization Specialist II