Authorization Specialist

The Specialist is responsible for completion of all patient insurance verifications in order to verify eligibility, coordinate medical benefits, submit prior authorizations, update patient account information and determine coverage/responsibility for services to be provided according to the ION standardized process.

Essential Functions:

· Verify all new, returning, and annual patient eligibility including private, government and third-party insurance information within assigned territory or clinics.

· Verify primary, secondary & tertiary medical benefits and patient responsibility such as deductible, out of pocket, copay and coinsurance.

· Verify if any prior authorizations are required pre-treatment such as HMO or PCP authorizations initiating authorization request and confirming with the office staff once received

· Utilize online insurance portals, phone communication and other eligibility tools in order to obtain accurate verifications and submit authorization requests based on verified authorization requirements

· Coordinate with Financial Counselor, Patient Navigator and front office staff to ensure smooth collection process.

· Maintains appropriate documentation in clinic systems and EMR.

· Submit accurate pertinent demographic and supporting clinical documentation with pre-authorization requests timely to avoid unnecessary delays in patient treatment

· Obtain and track authorizations for all patients for whom their insurance requires pre-authorization

· Provide accurate, complete updates to sites on status of verification & authorizations for all patients requiring treatment authorization

· Communicate with patients, front end staff, physicians & payors as needed in order to obtain updated insurance and/or clinical information

· Update patient account with all necessary insurance and authorization information

· Contribute to the design of a centralized VOB & authorization model working closely with the ION Revenue Cycle Managers

· Operate compliantly at all times by keeping patient data secure and confidential and adhering to all company policies and procedures

· Maintain excellent customer service and kindness with all patients and staff

· Regular attendance and punctuality.

· Execute all functions of the role with positivity and team effort by ensuring that all processing and reporting deadlines are consistently achieved.

· Perform any other functions as required by management

Qualifications and Education Requirements

· Minimum of 2 years in this field or related field such as medical coding, financial counseling setting or similar service profession.

· Must be proficient using a computer, online websites, and email.

· Knowledge of basic medical terminology, ICD-10 and CPT codes.

· Ability to work a flexible schedule (including overtime, and weekends, as necessary)

· High school graduate or equivalent

Preferred Skills

· Previous oncology background preferred

· Basic Excel knowledge

Required Competencies

Strong Business and Organizational Competence. Exceptional Customer Service Skills. Strong functional Competence. Interpersonal Skill Competency. Stress Tolerance. Initiative. Adaptability. Accountability. Integrity. Self-Confidence. Time Management Skills with an emphasis on multi-tasking.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Weekly day range:

• Monday to Friday

Experience:

• medical coding, financial counseling setting: 2 years (Required)
• Insurance verification: 2 years (Required)
• Authorizations: 2 years (Required)

Ability to Commute:

• Nashville, TN (Required)

Work Location: In person