Authorization Specialist

JOB SUMMARY

The basic function of the Authorization Specialist is to verify benefits/eligibility and obtain authorizations when necessary for visits, procedures, surgery, treatment, and testing with the patient’s corresponding insurance company as authorized by the physician. The Authorization Specialist will serve as a liaison between the clinical team, provider, outside facilities and the patient.

Monday - Friday 8:00am - 4:30pm

• Screens and analyzes the patient’s medical records for the documentation and criteria required to meet medical necessity for the authorization process.
• Obtains patients benefit information from the insurance company.
• Familiarizes self with medical policies and criteria for each insurance company.
• Follows up in a timely manner with the doctor’s team if additional information is needed.
• Reviews clinical documents with Nurse Reviewers and/or Utilization Managers at various insurance companies and third-party administrators.
• Coordinates with other OSS department staff, external facility staff and external companies to ensure authorization/referral is obtained.
• Communicates with external locations to ensure shipment of injection to OSS.
• Ensures authorization is secured with the insurance company prior to scheduled service.
• Obtains authorization timely when the service requires an auth prior to scheduling.
• Contributes to the development and delivery of team training initiatives.
• Communicates with physician’s team to notify patients when unsuccessful at obtaining pre-certification/authorization.
• Documents the results of the process in the EMR systems for future reference and for claims processing.
• Addresses concerns of insurance companies as well as patients in a professional, calm and understanding fashion.
• Maintains an orderly and neat work area.
• Maintains confidentiality and always protects sensitive data, including and not limited to patient information.
• Maintains performance in alignment with audit standards set by the team/department.
• Creates and modifies vendor reports.
• Other duties as assigned.

• High School Diploma or equivalent required;
  Licensed Practical Nurse (LPN) or certified Medical Assistant (MA) highly preferred.

• One-year relevant experience in the medical field or in prior authorization required.
• Must have basic knowledge and understanding of CPT/ICD
  10 codes for insurance verification. Must have basic knowledge and understanding of medications, advanced imaging studies and surgical procedures.
• Must have strong clinical knowledge and understanding of medical terminology and anatomy. Orthopedic knowledge is preferred.
• Must have proficient computer skills, including Microsoft Office, and skills utilizing basic office equipment.
• Must be detail oriented, have excellent organizational and prioritizing skills and be able to meet competing deadlines.
• Must possess a high level of analytical skills and critical thinking.
• Must be able to work independently. Must be able to demonstrate initiative to provide quality and improve efficiency with an assigned workload.
• Must have excellent communication skills, both written and verbal, to ensure communication is accurate.
• Must have good telephone etiquette, and be able to answer the phones, identify self and direct calls appropriately.
• Must be able to demonstrate flexibility by adapting to new and changing duties to meet patient needs effectively and with efficiency.

• Competitive Wages
• Medical, Dental, Vision available on the first day of employment
• Disability, and Life Insurance within 90 days
• Company-Paid Group Life Insurance, Short-Term Disability & Long-Term Disability
• Paid Time Off (PTO)
• 401(k) plan and profit sharing
• Career Advancement Opportunities