Medical Authorization Specialist

Department: Business Office

Immediate Supervisor Title: Authorizations Department Lead

Responsibilities

• Handles the verification of insurance benefits for patients
• Notifies patient of deductibles and co-insurance due as needed
• Contacts primary care physicians in regard to referrals
• Request referrals for services, including appointments and procedures
• Regularly calls insurance companies to follow up
• Explores other payment options with customer when needed
• Keeps sensitive patient and company information confidential
• Contacts patient when needing to obtain information
• Request, track and obtain pre-authorization from insurance carriers within time allotted

for medical and services.

• Review patient's medical history and insurance coverage for approval
• Contact referring physicians for additional information as needed
• Input new patient information and update information in our system
• Monitor schedule for potential issues
• Complete billing documentation
• Assist with other clerical tasks as needed
• Secure prior authorizations prior to services being performed.
• Demonstrate and apply knowledge of medical terminology, high proficiency of general

medical office procedures including HIPAA regulations.

• Communicate any insurance changes or trends among team.
• Maintains a level of productivity suitable for the department.
• Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.

• Regular attendance required
• Performs other related duties as assigned or requested.
• The company reserves the right to add or change duties at any time.

Qualifications

Education: High School diploma or GED required

Experience: Minimum 2 years of workers compensation

Experience: Minimum of 1 year experience as a medical biller/coder

Experience with electronic scheduling system and electronic medical records (EMR) required.

Familiar with medical terminology

Knowledge

Performance Requirements:

• Knowledge of principles and processes for providing customer and personal services.

This includes customer needs assessment, meeting quality standards for services, and evaluation

of customer satisfaction.

• Knowledge of administrative and clerical procedures and systems such as word

processing, managing files and records, stenography and transcription, designing forms, and other office procedures and terminology.

Skills

• Skill in identifying patient concerns and correcting or notifying supervisor.
• Actively listening and speaking to patients and understand and ask questions to ensure patient experience is at the highest level.

Abilities

• Ability to read and write instructions, and comprehend simple instructions, short correspondence, and memos.
• Ability to competently use Microsoft Office.