Authorization Specialist

Summary The Authorization Specialist, a key position in the Revenue Cycle, obtain authorizations/reauthorizes all procedures, surgeries, and medications/injectable. This position requires excellent follow-up and correspondence with external sources such as hospital/surgery centers, providers, patients, and insurance inquiries/correspondence.

Supervisory responsibilities

This role has no supervisory responsibilities.

Essential functions

The following list is a summary of the key functions of the job and may not be inclusive of all duties assigned.

Contact insurance carriers to verify patient’s insurance eligibility, benefits and requirements.

Request, track and obtain pre-authorization from insurance carriers within time allotted for services.

Request, follow up and secure prior-authorizations prior to services being performed.

Communicate any insurance changes or trends among team.

Maintains a level of productivity suitable for the department.

Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.

Attend and participate in meetings and training

Complying with rules, regulations, policies, and procedures for collecting payments.

Performing other duties as assigned.

Core Competencies All employees of L.O. Eye Care are expected to demonstrate the following core competencies, regardless of position or status. Additional job-specific competencies may be required of each position.

Communication – Ability to communicate effectively both verbally and in writing.

Conscientious – Ability to feel obligated to do right or be good along with awareness of one’s own conduct, intentions, or character.

Teamwork – Ability to work well in groups, develop and maintain positive working relationships, help resolve conflict, and support team goals.

Adaptability – Ability to adapt to change, be open to new ideas, handle pressure and uncertainty, and adjust work plans to meet changing company needs.

Trustworthy – Ability to be worthy of confidence and create assured reliance on the character, ability, and truth of own self.

Patient Confidentiality – Ability to maintain patient confidentiality, and hold others accountable to such, in accordance with the highest ethical standards.

Other duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Work environment

Work from home and/or typical office environment.

Physical demands/potential hazards

Must be able to sit for prolonged periods, must be able to use eyes, hands, and body to maintain office dexterity and mobility; may be required to lift typical office equipment up to 20 pounds.

Travel required0-25% travel required.

Education and experience

Educational requirements that are job-related and consistent with business necessity

High School Diploma or G.E.D. required.

Previous medical billing experience with knowledge of billing related reporting.

Three to five years’ experience in health-care (billing or clinical).Experience working with medical payers and vision insurance.

Demonstrated knowledge of medical terminology with high proficiency in general medical office procedures including HIPAA regulations.

Working knowledge of medical billing systems, Nextgen a plus.

Working knowledge of CPT and ICD-9 & ICD-10 coding system.

Leadership and management experience

Leadership requirements that are job-related and consistent with business necessity N/AAdditional eligibility requirements

Work authorization/security clearance requirements

Must be authorized to work in the USEEO Statement It is…