[Hiring] Authorization Specialist II @61st Street Service Corp

Role Description

The Authorization Specialist II is responsible for verifying insurance policy benefit information, and securing payer required authorizations. This position is responsible for obtaining accurate and timely pre-authorizations for professional services prior to the patient’s visit, scheduled admission, or immediately following hospital admission. Prior authorizations may include, but are not limited to:

• Surgical procedures
• Outpatient treatments
• Medications
• Diagnostic testing (i.e. ultrasounds, labs, radiology, IV therapy, referrals)

Job Responsibilities:

• Verifies insurance coverage via system tools, payer portals, etc. and updates changes in billing system.
• Confirms provider’s participation status with patient’s insurance plan/network.
• Determines payer referral and authorization requirements for professional services.
• Contacts patient and PCP to secure payer required referral for planned services.
• Documents referral in practice management system.
• Researches system notes to obtain missing or corrected insurance or demographic information.
• Reviews clinical documentation to ensure criteria for procedure meets insurance requirements.
• Initiates authorization and submits clinical documentation as requested by insurance companies.
• Follows through on pre-certifications until final approval is obtained.
• Communicates with surgical coordinators regarding authorizations status or denials.
• Submits appeals in the event of denial of prior authorizations or denial of payment following procedures.
• Sets up peer to peer calls with clinical providers and insurance companies, as needed.
• Calculates and documents patient out of pocket estimates and provides to patient.
• Assists Supervisor with special projects and/or tasks.
• Assists Authorization-Referrals Specialist I with complex cases or questions.
• Serves as back-up to Authorization-Referrals Specialist III.
• Performs other job duties as assigned.

Qualifications

• High school graduate or GED certificate is required.
• A minimum of 1-year experience in a physician’s billing or third payer environment.
• Ability to understand and navigate managed care eligibility, insurance billing requirements, and obtaining pre-authorizations.
• Strong customer service and patient focused orientation.
• Effective communication skills both verbally and written.
• Ability to multi-task, prioritize, document, and manage time effectively.
• Functional proficiency in computer software skills (e.g. Microsoft Word, Excel, Outlook, E-mail, etc.).
• Functional proficiency and comprehension of medical terminology.
• Experience in Epic and/or other electronic billing systems is preferred.
• Knowledge of medical terminology, diagnosis and procedure coding is preferred.
• Previous experience in an academic healthcare setting is preferred.

Requirements

• This position is primarily remote; candidates must reside in the Tri-State area (New York, New Jersey, or Connecticut).
• Occasional requirements to visit the New York or New Jersey office for training, meetings, and other business needs.
• Travel and accommodation costs associated with these visits will be the employee's responsibility and not reimbursed by the company.

Benefits

• Competitive comprehensive benefit package to eligible employees.
• Healthcare and various other benefits including Paid Time Off to promote a healthy lifestyle.

Company Description

At 61st Street Service Corporation we are committed to providing our client with excellent customer service while maintaining a productive environment for all employees. We are an equal employment opportunity employer and we adhere to all requirements of all applicable federal, state, and local civil rights laws.