Authorizations Specialist
Location: REMOTE or HYBRID
Entity: Alliance Health System
Reports To: Director of Authorizations
Authorization Specialist is responsible for obtaining prior authorizations for all treatment by successfully completing the authorization process with all commercial, automobile and workers compensation payers.
RESPONSIBILITIES
- Review chart documentation to ensure patient meets medical policy guidelines
- Prioritize incoming authorization requests according to urgency
- Obtain authorization via payer website, fax or by phone and follow up regularly on pending submission
- Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
- Initiate appeals for denied or modified authorizations
- Respond to clinic questions regarding payer medical policy guidelines
- Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
- Other duties as assigned
KNOWLEDGE, SKILLS, AND ABILITIES
- Knowledge of treatment authorization and its direct impact on the practice's revenue cycle
- Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively
- Proficient use of CPT and ICD-10 codes
- Excellent computer skills including Adobe, Excel and Internet use
- Detail oriented with above average organizational skills
- Plans and prioritizes to meet deadlines
- Excellent customer service skills; communicates clearly and effectively
- Ability to efficiently manage and prioritize time-sensitive tasks that arise
EDUCATION/EXPERIENCE REQUIRED
- High School Diploma or GED
- 2 years medical prior authorization experience preferred
- 2 years experience with MD providers - Orthopedics & Pain preferred.
Job Type:
- Full-time
- Monday to Friday
Benefits:
- 401(k) matching
- Health insurance
- Paid time off
- Paid Holidays
Background Check Requirement: Employment is contingent upon the successful completion of a background check, which may include verification of employment history, education, criminal records, and other relevant information as permitted by law.
