Authorization Specialist III Remote

Top Healthcare Provider Network

The 61st Street Service Corporation, provides administrative and clinical support staff for Columbia Doctors
. This position will support Columbia Doctors, one of the largest multi-specialty practices in the Northeast. Columbia Doctors’ practices comprise an experienced group of more than 2,800 physicians, surgeons, dentists, and nurses, offering more than 240 specialties and subspecialties.

There may be occasional requirements to visit the New York or New Jersey office for training, meetings, and other business needs.

The Authorization Specialist III is responsible for verifying insurance policy benefit information, securing payer required authorization prior to the patient’s visit, scheduled admission, or immediately following hospital admission. This position is responsible for obtaining accurate and timely pre‑authorizations for professional services. The Authorization Specialist III is also responsible for assisting management with the daily work assignment, staff training, and quality audits.

• 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 authorization requirements for professional services.
• Research system notes to obtain missing or corrected insurance or demographic information.
• Reviews clinical documentation to ensure 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. Responds to voicemails and emails.
• 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.
• Assists Supervisor with special projects and/or tasks.
• Assists Authorization Specialist I and II with complex cases or questions pertaining to the clearance of payer authorization or insurance eligibility issues.
• Assist supervisor/manager with distribution of daily work assignments.
• Assist with new-hire training and staff refresher training materials.
• Monitor and replenish the unit’s office supply needs.
• Assist management team with performing periodic quality audits.
• Performs other job duties as assigned.

Please note:

While this position is primarily remote, candidates must be in a Columbia University approved telework state. There may be occasional requirements to visit the office for meetings or other business needs. Travel and accommodation costs associated with these visits will be the employee's responsibility and not be reimbursed by the company.

• High school graduate or GED certificate is required.
• A minimum of 2 years’ experience in a physician’s billing or third payer environment.
• Candidate must demonstrate the ability to understand and navigate managed care eligibility, insurance billing requirements, and obtaining pre-authorizations.
• Candidate must demonstrate a strong customer service and patient focused orientation and the ability to communicate, adapt, and respond to complex situations. Including the ability to diffuse complex situations in a calm and…