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

Role Description

The Authorization Specialist III is responsible for verifying insurance policy benefit information, securing payer required authorization prior to the patient’s visit, scheduled admission, or immediately following hospital admission. This position is responsible for obtaining accurate and timely pre-authorizations for professional services. The Authorization Specialist III is also responsible for assisting management with the daily work assignment, staff training, and quality audits.

Job Responsibilities

• Verifies insurance coverage via system tools, payer portals (Electronic Query (Real-Time-Eligibility [RTE]/Insurance Payer Portal/Phone).
• Upon verification of patient's insurance coverage, updates changes in the billing system.
• Confirms provider’s participation status with patient’s insurance plan/network.
• Determines payer authorization requirements for professional services.
• 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.
• Manages faxes, emails, and phone calls. Responds to voicemails and emails.
• 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 Specialist I and II with complex cases or questions pertaining to the clearance of payer authorization or insurance eligibility issues.
• Assists supervisor/manager with distribution of daily work assignments.
• Assists with new-hire training and staff refresher training materials.
• Monitors and replenishes the unit’s office supply needs.
• Assists management team with performing periodic quality audits.
• Performs other job duties as assigned.

Qualifications

• High school graduate or GED certificate is required.
• A minimum of 2 years’ experience in a physician’s billing or third payer environment.
• Candidate must demonstrate the ability to understand and navigate managed care eligibility, insurance billing requirements, and obtaining pre-authorizations.
• Candidate must demonstrate a strong customer service and patient focused orientation and the ability to communicate, adapt, and respond to complex situations, including the ability to diffuse complex situations in a calm and professional manner.
• Must demonstrate 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 and Outlook, E-mail, etc.).
• Functional proficiency and comprehension of medical terminology.
• Certified Professional Coder certificate (CPC) is preferred.
• 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

• Hourly Rate Ranges: $28.72 - $36.92
• Note: Our salary offers will fall within these ranges based on a variety of factors, including but not limited to experience, skill set, training and education.

Benefits

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