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Insurance Authorization Specialist

Hubkom Billing Solutions

发布 Jun 03, 2023 192 查看

Insurance Authorization Specialist

Hubkom Solutions is currently seeking an Authorization specialist to join our team. As an Authorization specialist, you will play a vital role in ensuring that all necessary approvals and authorizations are obtained for various processes and activities within the organization.

Responsibilities

The Insurance Authorization Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers
Review chart documentation to ensure the patient meets medical policy guidelines
Prioritize incoming authorization requests according to the urgency
Obtain authorization via the payer website or by phone and follow up regularly on pending cases
Maintain individual payer files to include up-to-date requirements needed to successfully obtain authorizations
Communicates with the ordering physician and/ or APP in the case of denials that will require rescheduling and/or peer-to-peer review by the ordering physician
Initiate appeals for denied authorizations
Respond to clinic questions regarding payer medical policy guidelines
Confirm the accuracy of CPT and ICD-10 diagnoses in the procedure order
Contact patients to discuss authorization status

QUALIFICATIONS

Previous experience in pre-authorization/pre-certification and processing of health insurance claims
Medical terminology
Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively
Excellent computer skills including Excel, Word, and Internet use
Detail-oriented with above-average organizational skills
Plans and prioritizes to meet deadlines
Excellent customer service skills; communicates clearly and effectively
Ability to multitask and remain focused while managing a high-volume, time-sensitive workload

SCHEDULE