Spec Authorization

Responsibilities

• Verifies patient insurance coverage timely utilizing phone or online resources.
• Submit prior authorizations to insurances in timely matter via payer specific portals and vendors
• Ensures all pertinent medical documentation is accurate and present prior to authorization submission.
• Follows up with pending authorizations on a regular basis to obtain the current status or to be informed of any action needed in order to obtain the authorization approval.
• Communicates any authorization denials to the appropriate staff.
• Handles any discrepancies, errors, or omissions of authorization denials and files appeals when necessary for overturn of adverse decision.
• Participates in educational activities and attends regular staff and department meetings.
• Exhibit and manage excellent turn-around time in order to ensure timely authorizations.
• Consistently work in a positive and cooperative manner with fellow team members and management.
• Demonstrate flexibility to perform duties wherever volume deems it necessary.
• Collaborate with other departments to assist in obtaining pre-authorizations in a cross functional manner.
• Document activities appropriately in process notes.
• Participates in the Quality Assurance plan.
• Complies with applicable CLIA and HIPAA regulations.
• Stay up to date with SOPS
• Complies with all company and department policies and procedures
• Contributes to a positive work and team culture

Qualifications

• High school diploma or GED equivalent required
• 3-5 years of experience working in medical billing, health insurance or collections with demonstrated results preferred.
• Insurance billing experience is preferred.
• Good problem solving and decision-making skills.
• Excellent customer service and phone skills.
• Excellent time management, organizational, communication, multitasking and teamwork skills.
• Working knowledge of ICD-10, CPT and HCPCS coding (preferred but no required).
• Ability to successfully navigate between multiple systems throughout the course of the workday this includes but is not limited to billing software, written Standard Operating Procedures and payer portals.
• Preferred authorization experience

Physical & Lifting Requirements

• Lifting Requirements - light work or exerting up to 20 pounds of force frequently.
• Physical Requirements - stationary positioning, moving, operating, ascending/descending, communicating and observing.
• Use of equipment and tools necessary to perform essential job functions.

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