Insurance Authorization Specialist

Role Overview

• Responsible for performing initial and concurrent insurance authorization securement, clinical submission and denial prevention for all patients admitted to the hospital for clients.
• Confirm that a patient’s health insurance(s) is active and covers the patient’s procedure; may be completed multiple times during, and after a patient’s visit/stay.
• Confirm what benefits of a patient’s upcoming visit/stay are covered by the patient’s insurance(s) including exact coverage, effective date of the policy, coverage limitations / requirements, and patient liabilities for the type of service(s) provided.
• Check benefits to determine deductible, coinsurance, and copayment amounts due.
• Ensure payer requirements including the following are met: Verify and document insurance eligibility; confirm and document benefits.
• Review and submission of clinical documentation to ensure the treatment/services are appropriate for the diagnosis as determined.
• Obtain and verify that insurance authorizations are obtained and maintained on designated patients.
• Ensure that initial and all subsequent authorizations are obtained in a timely manner.
• Work to reduce and eliminate authorization denials.
• Review and analyze patient visit information to determine whether authorization is needed and understand payor specific criteria to appropriate secure authorization and provide clinical to support medical necessity.
• Ensure that services provided to eligible members are within benefit plan and appropriate contracted providers are being utilized.

Requirements

• Must have experience working with insurance companies and/or medical authorizations.
• Must have comprehensive understanding of insurance authorization requirements, contract benefits, CPT codes and medical terminology.
• Work requires a high level of critical thinking and problem-solving skills and the ability to retain material quickly.
• Must demonstrate a positive demeanor, solid verbal and written communication skills, and be professional in both appearance and approach.
• Must be able to handle considerably stressful situations and multiple tasks simultaneously.
• Must be able to demonstrate a working knowledge of personal computers and other standard office equipment.
• Work requires the ability to access online insurance eligibility and pre-certification systems.
• Must be able to successfully complete additional job-related training when offered.

Benefits

• Remote Work
• Bonus Incentives
• Paid Certifications
• Tuition Reimbursement
• Comprehensive Benefits
• Career Advancement