Become An Authorization Specialist

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Working As An Authorization Specialist

Interacting With Computers
Getting Information
Documenting/Recording Information
Organizing, Planning, and Prioritizing Work
Processing Information

Deal with People
Mostly Sitting
Repetitive
$50,237
Average Salary

What Does An Authorization Specialist Do At Medtronic

* Initiates follow-up activities regarding open authorizations, makes written and verbal inquiries to payors.
* Analyzes and problem solves account issues to full resolution.
* Provides support for inquiries from internal and external customers regarding account/authorization status.
* Maintains updated information on patient accounts.
* Handles internal and external customer inquiries regarding authorization status and insurance verification history.
* Performs eligibility verifications on patient accounts as new insurance plans/carriers are identified; updates information on expired insurance plans/carriers.
* Researches issues off-line as needed with payor/physicians/ patient; conducts follow-up calls with customers, initiating conference calls between insurance carrier and patients to resolve customer concerns.
* Meets or exceeds key performance indicators measuring productivity, quality, and service level as defined by Senior Management.
* Additional team activities, projects, and work flow as assigned.
* IN ORDER TO BE CONSIDERED FOR THIS POSITION

What Does An Authorization Specialist Do At Geisinger Health System

* Acts as coordinator between all Revenue Cycle teams/departments, Utilization Management/Care Management, Providers, GHS departments, clinical departments and patients concerning Revenue Cycle activity services which are ordered by all Geisinger Health System providers and External Providers regardless of the facility.
* Completes precertification using appropriate review criteria (Interqual Criteria, CMS criteria, and Third party payor criteria).
* Establish and maintain communication with all Geisinger Health System Providers, Nurses, and office staff to ensure completion on all peer to peer reviews and denials.
* Conducts research and follow-up activities on assigned accounts according to established procedures and time frames.
* Responsible for reviewing for accuracy of information requested and received in regard to precertification and/or prior authorization numbers received, as well as supporting documents and clinical documentation.
* Assists physicians, insurance companies, employers, and other parties with request concerning prior authorization to result in positive resolution.
* Coordinates efforts with other departments to resolve financial clearance, insurance, billing, collection, and/or other related concerns/issue's.
* Completes and updates hospital and clinical accounts reviewed via Epic.
* Ensures compliance with federal, state, and other third-party billing requirements including HCPCS, ICD
* coding, HIPAA and medical terminology.
* Responsible to be available to answer patient questions pertaining to status of precertification.
* Responsible to contact patients and the provider when precertification is denied greater than 72 hours from scheduled service.
* Verifies insurance, precertification and documentation surrounding all of the claim resolution.
* Physician collaboration regarding denials and medical necessity of peer review.
* Responsible for accurately, completely and consistently obtaining Precert at the department standards.
* Performs other duties as required or assigned by emergency or other operational reasons for which the employee is qualified to perform

What Does An Authorization Specialist Do At Mercy Health

* The Insurance Authorization Specialist is responsible for selecting accurate medical records for patient safety, and working with insurance companies and/or physician offices to complete insurance authorization requirements to secure payment.
* Identify the appropriate clinical records and submit the authorization request to the insurance company based on plan requirements for approval.
* Will be the liaison between the ordering physician and insurance company to ensure any and all requirements to secure approval are identified and communicated
* Among the expectations of this role, the Specialist will achieve:* >95% accuracy/quality while handling accounts* >95% quality of expected customer service etiquette
* Meet or exceed Lower controls of average productivity amongst the Insurance Authorization Specialist I productivity standards
* Insurance Authorization Specialist will receive benefits:
* Competitive compensation and benefits packages that reflect our commitment to providing fair and just workplaces.
* Wellness programming designed to help our associates enhance their health, including a comprehensive annual health risk assessment.
* A culture truly participatory and to strengthen diversity and inclusion.
* Growth
* Once you've joined our team, you will discover a variety of traditional and online learning opportunities, including tuition reimbursement, to help you acquire new skills and obtain degrees, certifications and CEUs.
* And our managers will coach you toward greater success.
* Recognition
* We recognize our associates through programs that include service awards, celebrations and personal appreciation.
* We also survey associates annually to assess their satisfaction with our organization and managers, and to identify areas for improvement

What Does An Authorization Specialist Do At Leidos

* Work with a team of ONI Security Controls Assessor (SCA) Representatives and the INFOSEC Customer Support Desk and be responsible for administration, support, and assistance to the Delegated Authorizing Official (DAO), DAO Representatives, the Security Control Assessor (SCA), SCA Representative, Information Systems Security Managers (ISSM), Information Assurance Managers (IAM), Information Assurance Officers (IAO), Program Offices, and Security Engineers as warranted.
* Advise on all matters pertaining to IA, with experience establishing and managing A&A teams, and adapting industry , DoD, and IC standards to create best practices; Perform SCI system assessment support via databases e.g.
* Xacta; Authorization to Operate (ATO) package development, review, and processing and reviewing Naval message traffic.
* Ensure compliance to FISMA, ICD
* DCID 6/3, DJSIG, and ICS 500
* along with additional community guidance.
* TA_4

What Does An Authorization Specialist Do At UPMC

* General responsibilities
* Maintains compliance with departmental quality standards and productivity measures.
* Works collaboratively with internal and external contacts to enhance customer satisfaction and process compliance, to avoid a negative financial impact.
* Utilizes 18
* UPMC applications and payor/ contracted provider web sites to perform prior authorization, edit, and denial services.
* Provides on the job training for the Authorization Specialist.
* Utilize authorization resources along with any other applicable reference material to obtain accurate prior authorization.
* Prior authorization responsibilities
* Reviews and interprets pertinent medical record documentation for patient history, diagnosis, and previous treatment plans to pre-authorize insurance plan determined procedures to avoid financial penalties to patient, provider and facility.
* Utilizes payor-specific criteria or state laws and regulations to determine medical necessity for the clinical appropriateness for a broad scope of services and procedures considered effective for the patient's illness, injury, or disease.
* Obtains appropriate diagnosis, procedure, and additional service codes to support medical necessity of services being rendered using pertinent medical record and ICD
* CM, CPT, and HCPCS Level II resources.
* Submits pertinent demographic and supporting clinical data to payor to request approval for services being rendered.
* Provides referral/pre-notification/authorization services timely to avoid unnecessary delays in treatment and reduce excessive administrative time required of providers.
* Retrospective authorization responsibilities
* Reviews insurance payments and remittance advice documents for proper processing and payment of authorization claims, as appropriate.
* Audits authorization related data errors and/or completes retro-authorizations to resolve unprocessed or denied claims.
* Researches denials by interpreting the explanation of benefits or remittance codes and prepares appeals for underpaid, unjustly recoded, or denied claims.
* Submits requests for account adjustments/controllable losses to manager in accordance with departmental process.
* Identifies authorization related edit/denial trends and causative factors, collates data, and provides summary of observations.
* Communicates identified trends to Manager.
* Qualifications
* High School diploma or equivalent with four years of working experience in a medical environment (such as a hospital, doctors office, or ambulatory clinic) OR an Associate's degree and two years of experience in a medical environment required.
* Prior UPMC experience is preferred.
* Background in billing, payors, and/or claims is preferred.
* Bachelors degree (B
* A) preferred.
* Completion of a medical terminology course (or equivalent) required

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How To Become An Authorization Specialist

High school graduates who have experience using computer software applications, such as word processing and spreadsheets, usually qualify for entry-level positions. Although most secretaries learn their job in several weeks, many legal and medical secretaries require additional training to learn industry-specific terminology. Executive secretaries usually need several years of related work experience.

Education

High school graduates can take courses in word processing and office procedures at technical schools or community colleges. Some temporary placement agencies also provide training in word processing, spreadsheet, and database software.

Some medical and legal secretaries learn industry-specific terminology and practices by attending courses offered at community colleges or technical schools. For executive secretary positions, employers increasingly prefer to hire those who have taken some college courses or have a bachelor’s degree.

Training

Secretaries and administrative assistants typically learn their skills through short-term on-the-job training, usually lasting a few weeks. During this time they learn about administrative procedures, including how to prepare documents. Medical and legal secretaries’ training may last several months as they learn industry-specific terminology and practices.

Work Experience in a Related Occupation

Executive secretaries can gain experience by working in administrative positions that have less challenging responsibilities. Many secretaries and administrative assistants advance to higher level administrative positions.

Licenses, Certifications, and Registrations

Although not required, certification can demonstrate competency to employers.

The International Association of Administrative Professionals offers the Certified Administrative Professional (CAP) certification. Candidates must have a minimum of 2 to 4 years of administrative work experience, depending on their level of education, and pass an examination.

Legal secretaries have several certification options. For example, those with 1 year of general office experience, or who have completed an approved training course, can acquire the Accredited Legal Professional (ALP) certification through a testing process administered by NALS (previously known as National Association of Legal Secretaries). NALS also offers the Professional Legal Secretary (PLS) certification, considered to be an advanced certification for legal support professionals.

The Certified Legal Secretary Specialist (CLSS) certification is conferred by Legal Secretaries International in areas such as intellectual property, criminal law, civil litigation, probate, and business law. Candidates typically need to have 5 years of legal experience and pass an examination to become certified.

Advancement

Secretaries and administrative assistants generally advance to other administrative positions with more responsibilities, such as office supervisor, office manager, or executive secretary.

With additional training, many legal secretaries become paralegals or legal assistants.

Important Qualities

Integrity. Many secretaries and administrative assistants are trusted to handle sensitive information. For example, medical secretaries collect patient data that is required, by law, to be kept confidential in order to protect patient privacy.

Interpersonal skills. Secretaries and administrative assistants interact with clients, customers, or staff. They should communicate effectively and be courteous when interacting with others to create a positive work environment and client experience.

Organizational skills. Secretaries and administrative assistants keep files, folders, and schedules in proper order so an office can run efficiently.

Writing skills. Secretaries and administrative assistants write memos and emails when communicating with managers, employees, and customers. Therefore, they must have good grammar, ensure accuracy, and maintain a professional tone.

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Top Skills for An Authorization Specialist

Top Authorization Specialist Skills

Insurance Companies
Customer Service
Medical Records

You can check out examples of real life uses of top skills on resumes here:

Communicated with patients, doctors and insurance companies on a daily basis.
Communicated issues with patient or customer service representative if order was incorrect.
Obtained and submitted medical records, prescriptions and insurance authorization requests.
Provided CPT and ICD9 coding on IVR questionnaires forms.
Obtain pre-authorization for surgical procedures as required by the patient's insurance plan.