Authorization Specialist

Join to apply for the Authorization Specialist (48009) role at Access Sports Medicine & Orthopaedics
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The Authorization Specialist is responsible for ensuring all patients receive proper authorization before their procedures to avoid delays. When a prior authorization is not approved or is pending, the specialist works with relevant individuals to obtain necessary documentation so procedures can proceed on time and patients understand their financial obligations.

Essential Functions Include But Are Not Limited To

• Ability to obtain benefits and authorizations for surgery patients and other procedures as required.
• Request peer-to-peer review by mid-level clinicians for any denied surgery or procedure authorizations.
• Obtain retro authorizations or add CPT codes to original surgery authorization for the billing department.
• Schedule all outside testing once authorization is obtained (e.g., CT scans, bone scans, stat ultrasounds, dexascans, cortisone injections, infusions, and wound care).
• Write letters of medical necessity for DMEs, other patient visits, etc.
• Request out-of-network authorizations/gap exceptions as needed for patients having insurance that is out of network.
• Maintain good interpersonal skills in establishing effective working relations with staff.
• Effectively train new staff members.
• Handle & protect patient information.
• Promote internal and external customer satisfaction.
• Build and promote a culture of service excellence and continuous improvement.
• Attendance: works as scheduled and complies with the Attendance and Tardiness Policy.
• Perform all other duties as assigned.

Education & Qualifications

• Required:
  
  High School graduate or equivalent.
• Preferred:
  Associate’s degree; billing or authorization experience.

Seniority level:
Entry level

Employment type:

Full-time

Job function:
Other

Industry: Medical Practices