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SalaryThe Authorization Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial, insurance-managed Medicare Advantage plans and other payors as required.
As an Authorization Specialist, you will play a crucial role in ensuring the smooth operation of our medical office. Your primary responsibilities will include:
Job Qualifications
Education:
- High School Diploma or GED
- Associate Degree Preferred
Experience:
- Minimum 2 years experience in a medical-related field (preferably Home Health/Hospice)
- 2 years of medical prior authorization experience preferred.
- EMR/Software: HomeCare Home Base, Availity, Microsoft Platforms Preferred
Knowledge and Skills:
As an Authorization Specialist, you will play a crucial role in ensuring the smooth operation of our medical office. Your primary responsibilities will include:
- Strong knowledge of medical coding systems, including ICD-10
- Familiarity with insurance verification processes and procedures
- Proficiency in using medical office software and electronic health record systems
- Attention to detail and ability to maintain accurate records
- Excellent communication skills, both verbal and written
- Ability to work collaboratively with healthcare providers, insurance companies, and patients
- Knowledge of procedure authorization and its direct impact on the company’s revenue cycle
- Understanding of payer medical guidelines while utilizing these guidelines to manage authorizations
- Excellent computer skills, including Excel, Word, and Internet use
- Detail-oriented with above-average organizational skills
- Plans and prioritizes to meet deadlines
- Excellent customer skills; communicates clearly and effectively
- Ability to multitask and remain focused while managing a high-volume, time-sensitive workload
Transportation: Reliable transportation with valid and current auto insurance.
Travel: < 5%
Environmental and Working Conditions:
Works in various settings and office environments, promoting functioning and coordination with all agency activities to ensure the highest level of professional care—the ability to work a flexible schedule.
Physical and Mental Effort:
Must be able to work under stressful conditions and time constraints of the agency or projects. Work requires sitting for long periods, bending, and stretching for files and office supplies. It may occasionally require lifting files or paper weighing up to 30 pounds.
Essential Functions:
- Obtaining authorizations from insurance companies for medical procedures and services
- Reviewing medical records and coding information to ensure accuracy and compliance with HIPAA regulations
- Collaborating with healthcare providers and insurance companies to resolve authorization issues
- Maintaining accurate and up-to-date records of authorizations and insurance information
- Prioritize incoming authorization requests according to urgency.
- Obtain authorization via payer website/portal or by phone/fax and follow up regularly on pending cases
- Obtain appropriate medical records from the source system to submit with prior auth per payor-specific guidelines
- Maintain individual payer files to include up-to-date requirements needed to obtain/initiate appeals for denied authorizations successfully
- Respond to agency questions regarding payer prior auth/medical guidelines
- Other duties as assigned
Equal Employment Opportunity:
Traditions Health is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination of any kind based on race, color, sexual orientation, national origin, disability, genetic information, pregnancy or any other legally protected characteristic.
