Authorization specialist job description

Authorization Specialist
Pay: $18-21/hr (based on experience)
Job Type: Full-time, Permanent
Hours: M-F Flexible 8-hr day between 7AM-8:30AM start time
Location: Nashville, TN (hybrid - 3 days in office, 2 days remote)

The purpose of the Classification/Authorization Specialist role is to complete relevant documents and follow established protocol to either close out these documents and/or to ensure relevant documents flow to the proper channel. Review authorization documentation and accurately collect required financial information for all subscribers from multiple key stakeholders ranging from Government to Local Agencies, while utilizing current skills to accurately multitask in a fast-paced environment. If you want to positively impact patient lives by joining a successful healthcare company, apply today!

A Day in the Life:
Review and process all incoming documents via multiple programs, updating subscriber specifics systems as needed Obtaining and entering Medicaid authorizations for treatment from various payers and following up on authorization requests, running reports, and identifying expiring authorizations Accurately maintaining patient files and current authorization information Coordinating with various locations regarding authorization statuses and assist with insurance verification and other billing office related activities Receive incoming documents, review and determine correct document classification.

Requirements:
2+ years in medical billing, authorization, or documentation review


Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.
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The following duties are specifically assigned to the Medication Authorization Specialist as required by the clinic:

The Medical Authorization Specialist is responsible for multiple facets of patient financial account services within the practice; including but not limited to patient benefit assessment, insurance verification (pre-certification, authorizations, determination) for services, and referrals management

Collaborates with physicians and provider office staff in ascertaining the appropriate authorization based on medical necessity and the treatment plan provided; communicates directly or indirectly with insurance companies

Requests authorization from various insurance companies by completing their assigned forms and/or accessing their website

Submits pertinent demographic and supporting clinical documentation with pre-authorization requests timely to avoid unnecessary delays in patient treatment.

Contacts doctors, patients, and insurance companies to obtain status and necessary information for pending requests
Provide cost estimates for procedures Appeals denials and/or set-up peer to peer reviews Performs on-going check and balance system to ensure the integrity of the patient billing data and processes renewals for expiring authorizations Ensures timely and accurate insurance authorizations for all CPT codes that will be charged during the course of the patient's treatment before services are rendered. This ensures the organization will be reimbursed by the insurance companies when billed Proofreads forms received from doctors for accuracy before sending to insurance company and the pre-authorizations received from the insurance companies Enters completed authorizations into electronic medical record Maintain clear, concise and accurate documentation of all attempts and/or contacts made and received for accounts in accordance with company and client specifications Maintains prior authorization tracking spreadsheet including data entry and reporting Assists in education and acts as a resource to clinicians and support staff regarding authorizations Provides updates to providers and clinic staff with authorization process information prior to the patient's treatment Maintains an approachable and appropriate attitude when interacting with all levels of personnel in a rapidly changing environment Eagerness and ability to work independently as well as part of a team with flexibility and willingness to learn and take initiative on variety of tasks and projects Facilitates submission of clean claims and reduction in payer denials by adhering to both organizational and departmental policies and procedures and maintaining departmental productivity and quality goals Appropriately prioritizes workload to ensure the most urgent cases are handled in a timely manner. Follows departmental policies and procedures when necessary authorization is not obtained prior to service date. Answers provider, staff, and patient questions surrounding insurance authorization requirements Answer multiple phone lines and takes messages. Notes in electronic medical record (EMR) any patient calls and tasks appropriate person for follow-up Schedules appointments and procedures Completes FMLA, disability, and return to work paperwork Prepares work and school excuse letters Performs other duties as assigned by the providers or clinic management
Requirements:
Committed to creating a believe, begin and become individualized patient experience as outlined in the declaration Committed to discovering the unique integration of my talents and passions and to do everything possible to develop them for our patients, Southeast and myself Excellent interpersonal skills demonstrated in interactions with patients, providers, and co- workers Excellent written and oral communication skills Demonstrate proficiency in Microsoft office suite within 90 days Minimum of high school education or GED is required Experience in a hospital or physician practice is preferred 1-2 years' experience in hospital billing/ pre-authorization or insurance verification with demonstrated knowledge of health insurance plans including: Medicare, Medicaid, HMO's and PPO's Working knowledge of musculoskeletal terminology is preferred Prior experience in a business office position with strong customer service background preferred Must be able to read, write, and speak English

The primary responsibility of the Clinical Success Team Specialist is to obtain initial and subsequent insurance authorizations for therapy services and populate response data in designated system(s) and provides administrative assistance and support to the Symbria management team as needed.
Work Schedule:
Monday - Friday 10:00 AM-6:30 PM(CST)- (possible rotating weekends)
Responsibilities
• Contact insurance products via Phone/Fax/Email/Portal/etc with necessary information to obtain initial and/or subsequent authorizations required for evaluation and/or therapy treatment.
• Populate Casamba or designated software system with insurance authorization approval information as obtained.
• Participate in the gathering of patient or responsible party signature or telephone approval on assignment of benefit forms where needed.
• Provide procedural feedback to optimize departmental effectiveness.
• Communicate with Symbria staff, clients, third party payors, and any other entity needed to complete assigned duties in a clear and concise manner.
• Any and all other duties as assigned.
Qualifications
EDUCATION AND OTHER QUALIFICATIONS REQUIRED
To perform this job successfully, the ability to perform each essential duty satisfactorily is necessary and the qualifications listed below are representative of the knowledge, skill, and/or ability required:
• High School diploma or general education degree (GED).
• Ability to translate medical terminology and interpreting orders for use in authorization process; minimum one year.
• Knowledge of general administrative procedures and experience; minimum two years.
• Ability to communicate effectively and efficiently in both written and verbal form.
• Ability to exercise outstanding client service relations and professional verbal and written communication skills.
• Excellent time management skills with proven ability to maintain organization, multi-task and pay attention to detail while working on several tasks simultaneously.
• Proficient use of computers and Microsoft Office: Word, Excel, and Outlook; advanced experience with Microsoft Excel preferred.