Authorization Specialist

OPEN UNTIL FILLED

JOB SUMMARY:

Perform and execute key tasks within the service authorization process.  This includes review of all registration and authorization requests for quality assurance, submission of requests, and follow-up completing the entire authorization process.  The Authorization Specialist works collaboratively with service providers, administrative staff, billing specialists and payers to properly complete the authorization request. 

ESSENTIAL FUNCTIONS: 

1. Upon notification in the electronic health record, review service authorization/registration request for quality assurance purposes prior to submission, for missing, incomplete, or incorrect data.  If needed, communicate with program staff to update information such as demographic elements.     
2. Submit authorization requests to appropriate payer through payer websites, phone, or fax.  Log the submitted request on appropriate spreadsheet for tracking purposes.  Enter pending authorization in the electronic health record.
3. Track pending requests by reviewing the spreadsheet log daily.  As approvals are received via fax and/or mail, update the log and pending authorizations in the electronic health record.  Enter an Auth Disposition service in the electronic health record with details of the outcome of the request, including approval, pended or denial information.  For requests that have not been resolved, contact the appropriate payer for request status via portal or telephone.  Determine status of submitted requests and update the electronic health record accordingly. 
4. Assist with reports in identifying services with no authorization or lapsed authorization.  Update authorizations as appropriate and/or submit billing adjustments if needed.    
5. Verify eligibility of coverage and benefits for insurances such as Medicaid, Medicare, managed care organizations, and other commercial insurances, etc., to ensure accurate insurance coverage.   Maintain access to all necessary payer websites and portals.   Establish payer in the electronic health record to ensure proper priorities and communicate with staff any additional needs or requirements for authorization and billing.
6. Assist with monthly statements to include folding of statements, inserting statements into envelopes and   processing statements through postage machine.  Update demographic information in the electronic health record as necessary, in response to returned mail.  
7. Maintain knowledge and skills pertaining to revenue cycle management, including webinars, conferences, payer-initiated trainings, and applicable meetings.  Must maintain knowledge of payer requirements by reviewing current memos, manuals, email updates, and payer trainings.

OTHER DUTIES: 

• When requested, serve on Agency committee dealing with billing and other reimbursement issues.
• Perform such other tasks as assigned by supervisor.

QUALIFICATIONS:

• Good oral and written communication skills.
• Understand and comply with policies and procedures.
• Work independently, and perform multiple tasks.
• Must be able to develop and maintain professional, service-oriented working relationships with individuals, providers, co-workers, and supervisors.
• Knowledge and skill of Agency electronic health record system.
• Knowledge and ability to navigate and perform work duties within multiple databases and portals.

EXPERIENCE/EDUCATION REQUIRED:

High school diploma.

Experience with reimbursement and/or authorization preferred.