Top Authorization Specialist Skills

Below we've compiled a list of the most important skills for an Authorization Specialist. We ranked the top skills based on the percentage of Authorization Specialist resumes they appeared on. For example, 24.4% of Authorization Specialist resumes contained Insurance Companies as a skill. Let's find out what skills an Authorization Specialist actually needs in order to be successful in the workplace.

The six most common skills found on Authorization Specialist resumes in 2020. Read below to see the full list.

1. Insurance Companies

high Demand
Here's how Insurance Companies is used in Authorization Specialist jobs:
  • Verified patient's insurance plan coverage eligibility and benefits and contacted insurance companies online and over the phone for surgery authorization.
  • Completed referral request from providers by obtaining prior authorization from insurance companies to obtain approval for visits.
  • Established good relationship with Prior Authorizations Departments of ALL insurance companies to guarantee speedy and correct authorizations.
  • Correspond with various insurance companies to obtain prior authorization needed for surgical procedures.
  • Correspond properly with health insurance companies to ensure medical benefits and verification.
  • Followed up and maintained monthly authorizations for patients through various insurance companies.
  • Verified eligibility and authorization status with insurance companies by phone or online.
  • Contacted insurance companies, verified insurance and obtained authorizations for services.
  • Obtain authorizations through various insurance companies for specialty durable medical equipment.
  • Obtained eligibility and authorizations from insurance companies for diagnostic testing.
  • Submit authorization requests to insurance companies per individual requirements.
  • Request for Prior Authorizations or Pre-Determination from insurance companies.
  • Verify patient s insurance eligibility with various insurance companies.
  • Developed & maintained relationships with patients and insurance companies.
  • Contacted insurance companies regarding authorization for workers compensation.
  • Contacted insurance companies to obtain authorization for treatment.
  • Coordinated with insurance companies to obtain authorizations.
  • Tracked regulations on multiple insurance companies cross-country.
  • Authorized Chemotherapy Drugs through insurance companies.
  • Contacted insurance companies for health insurance eligibility

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2. Medical Records

high Demand
Here's how Medical Records is used in Authorization Specialist jobs:
  • Followed up with Insurance Companies to ensure the accuracy and credibility of necessary medical records to complete orderly requests.
  • Greeted and received all incoming patients and collected/verified patient information into electronic medical records system.
  • Ensured accurate data entry and completion of authorization data from medical records, referral/authorization forms.
  • Verified patient insurance updated patient medical records and scheduled patient appointments.
  • Obtained and verified necessary medical records, demographics and insurance information.
  • Obtained and submitted medical records, prescriptions and insurance authorization requests.
  • Develop and maintain accurate medical records electronically.
  • Request further medical records to complete authorizations.
  • Review and research face sheets/ medical records in order to authorize inpatient hospital stays in accordance with policies and guidelines.
  • Coded medical records with ICD-9; processing claims daily while maintaining 95% accuracy and achieving productivity goals.
  • Assist medical records with the sending of medical reports as cover entities call and request them.
  • Maintain good filing system for providing copies of medical records when needed.
  • Provide medical records to worker's compensation insurances per their request.
  • Scan patient care chart reviews into the electronic medical records system.
  • Retrieve patient medical records from doctor offices for medical insurance companies.
  • Utilized EPIC system to retrieve electronic medical records (EHR).
  • Pulled and scanned medical records to other clinics and/or insurances.
  • Scanned documents and input medical records into the company database.
  • Provided receptionist fill in with the Medical Records Department.
  • Collect and send medical records to proper locations.

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3. Customer Service

high Demand
Here's how Customer Service is used in Authorization Specialist jobs:
  • Delivered high-level customer service in a fast paced medical imaging facility with a high patient volume.
  • Resolved exceptionally difficult customer satisfaction issues as a member of the Customer Service Support Group.
  • Provide excellent customer service to clinicians, insurance representatives and accounting departments.
  • Communicated issues with patient or customer service representative if order was incorrect.
  • Demonstrated excellent customer service and implemented problem resolution.
  • Provided customer service for future tenants, included assisting with the completion of applications and requirements to obtain housing assistance.
  • Provided customer service to the insurance companies and referring physician offices, along with other departments within the organization.
  • Assisted with end of month charge entry and billing assignments and answered incoming customer service calls.
  • Managed logistics fulfillment supporting 2 HR, 4 HR, & 24 HR Customer Service Contracts.
  • Communicated with nurses, social workers and doctors to provide optimal customer service to patients.
  • Succeeded in achieving a 98% customer retention rate with superb and efficient customer service.
  • Used customer service and listening skills to answer questions from parents and provide accurate information.
  • Handled medical documentation and customer service aspects of physicians and funding sources of duties.
  • Direct clients to the right answers regarding their investments while providing great customer service.
  • Delivered outstanding customer service to clients and sold over $15,000 in merchandise.
  • Provided customer service to homeowners, property management companies, and contractors.
  • Provide excellent customer service to patients by scheduling appointment when needed.
  • Assisted patients in person and via telephone with superior customer service.
  • Answer phones, coordinate fax communications and provide customer service.
  • Assist Customer Service, Install and Sale department when needed.

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4. Patient Care

high Demand
Here's how Patient Care is used in Authorization Specialist jobs:
  • Collaborate with insurance companies in acquiring prior authorization for selective medication and/or procedures pertinent to patient care.
  • Contacted insurance companies and other benefit providers to coordinate patient care.
  • Performed quality audits on field staff encounter/visit frequencies; Collaborate with case management division to ensure proper patient care and treatment.
  • Strive to ensure quality patient care by arranging patient admissions and discharges, and attending weekly patient staffing.
  • Perform reception, scheduling, order entry and other general clerical duties with support patient care teams.
  • Collaborated with the scheduling coordinator, providers, and intake team to ensure uninterrupted patient care.
  • Expedite urgent authorizations, and coordinating patient care with facilities and provider s offices.
  • Worked on a daily basis with Workers Comp to approve patient care.
  • Work with various departments including Patient Care and the Outside Team Members.
  • Fax documents to affiliates to meet deadlines of patient care information.
  • Obtained authorization from insurance companies for patient care.
  • Generated reports that tracked patient care information and created efficiencies.
  • Managed pre-authorizations for approximately 260-280 patients' daily ensuring patient care while managing company costs.
  • Discharge Planer San Juan, PR 2013 - 2015 Work as a liaison and triage between the inpatient and outpatient care.

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5. Clinical Staff

high Demand
Here's how Clinical Staff is used in Authorization Specialist jobs:
  • Develop positive working relationships with MCO s and KYC clinical staff to promote an understanding of Prior Authorizations requirements and processes.
  • Assist supervisor in identifying and analyzing patterns of claims denials and identifying corrective actions or training needs of clinical staff.
  • Work with registration and clinical staff to ensure proper CPT codes are submitted on authorization requests.
  • Utilized the Complaint Coding Module (CCM) and provided the clinical staff medical record documentation.
  • Assist clinical staff with setting up documents for Clinical Review.
  • Act as the liaison between clinical staff and insurance company.
  • Communicate closely with physician, clinical staff, healthcare providers and patient/family to ensure proper information is given to obtain authorization.

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6. Data Entry

high Demand
Here's how Data Entry is used in Authorization Specialist jobs:
  • Completed all data entry for all required documentation regarding patient procedures.
  • Performed administrative tasks including data entry and maintained patient databases.
  • Provided initial data entry related to potential quality issues.
  • Train, supervise and evaluate the performance of the Authorization Specialists, Nursing Secretary and Data Entry Clerk.
  • Performed clerical duties to include filing, data entry, word processing and co-pay collection.
  • Verify, track, and report consumer authorizations, including document review and data entry.
  • Manage advanced office documentation, data entry, filing, and scheduled diagnostic testing appointments.
  • Follow the billing guidelines for proper data entry as to have the services approved.
  • Performed data entry by applying payments from patients and insurance carriers to accounts.
  • Give change to different departments, Data Entry, Work admitting patients.
  • Perform filing, keeping track of necessary documents and data entry.
  • Team Lead, Data Entry, Ensuring reports are submitted daily.
  • Opened and sorted incoming mail and processed for data entry.
  • Managed data entry and maintenance of records for database.
  • Recognized and rewarded for quality calls and data entry.
  • Performed Data Entry and other paperwork related clerical task.
  • Request authorization for services Data Entry
  • Maintained current computerized plan of care of each paitient via data entry of care order written by clinical discipline.
  • Utilized the Centricity TES edit tool to check for missing and/or incomplete information during data entry for bill processing.
  • Maintain daily billing, data entry, and entering tasks in our system (Central Reach).

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7. CPT

high Demand
Here's how CPT is used in Authorization Specialist jobs:
  • Review medical record documentation and accurately code the primary secondary diagnoses and procedures utilizing ICD-9-CM and CPT coding conventions.
  • Coordinated with insurance company authorization department to resolve CPT code discrepancies.
  • Utilize CPT/ICD-9 codes and obtain insurance authorizations for the designated radiology procedures (MRI, CTSCAN, Nuclear Medicine and).
  • Utilized ICD-9/CPT coding to assist provider: notes on request, to approve, deny, or modify authorization.
  • Moderate knowledge of CPT and ICD9 Codes, interact with various interdepartmental staff and patients when necessary.
  • Review CPT and diagnosis codes to make sure they correspond with the medication being provided.
  • Process included assignment of CPT and ICD9 codes correlating benefits, authorizations and claims.
  • Identify and evaluate patients ICD-9 and CPT codes to determine eligibility for DME products.
  • Review billing forms for completeness and reference CPT/ICD codes for processing.
  • Converted narrative visit notes to ICD-9, CPT and HCPCS codes.
  • Display efficient knowledge with proper ICD 9 and CPT/HCPCS codes.
  • Work with a moderate amount of CPT and ICD10 coding.
  • Provided CPT and ICD9 coding on IVR questionnaires forms.
  • Confirmed accurate ICD9 and CPT codes for procedures.
  • Demonstrate working knowledge of ICD-9, CPT, and HCPCS codes and HIPAA laws.
  • Experience with DME, CPT, ICD-9 Coding.
  • Apply knowledge of ICD-9 and CPT Codes.
  • Worked with CPT and IDC9 Codes.
  • Communicate with the surgeon's office to obtain cpt codes, icd-9 codes to obtain current or retro authorizations.
  • Answer incoming calls assisting physician offices staff ordering process, given correct CPT codes.

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8. Input Insurance Authorization

high Demand
Here's how Input Insurance Authorization is used in Authorization Specialist jobs:
  • Obtain, review and input insurance authorization and referrals prior to patient services.

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9. Procedure Codes

high Demand
Here's how Procedure Codes is used in Authorization Specialist jobs:
  • Communicate with doctors to ensure all diagnosis and procedure codes are compatible for services rendered.
  • Review structured clinical data matching it against specified medical terms, diagnoses, and procedure codes.
  • Review clinical data matching procedure codes and diagnoses and follow established procedures for authorizing request or referring for further review.
  • Reviewed structured clinical data (non-clinical and structured clinical data) into procedure codes and follow established procedures for authorizing request.
  • Review data matching it against specific medical terms and diagnoses or procedure codes and follow established procedures for authorizing requests.
  • Review diagnoses or procedure codes and followed procedures for authorizing request or referring request for further review.

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10. Medicaid

high Demand
Here's how Medicaid is used in Authorization Specialist jobs:
  • Processed medical provider and patient data for Medicaid assistance in partnership with medical staff to ensure efficient and accurate payment operations.
  • Handle all generic Commercial and generic Medicaid authorizations for Maryland and Virginia inpatient stays for 5 hospitals.
  • Verified monthly Medicare/Medicaid eligibility, working directly with re- Determination paperwork or spend down clients.
  • Assisted Quality Assurance Director in administrative duties and confidential auditing of Medicaid client files.
  • Audit Medicaid implementations, to see if paid authorization met medically necessary policies.
  • Conducted Insurance verification of benefits for Medicare/Medicaid/Commercial payers throughout the United States.
  • Adhered to Medicare and Medicaid regulations per positions requirements.
  • Retain authorization from Medicaid and various private insurances.
  • Verified insurance eligibility, including Medicare and Medicaid.
  • Comprehended insurance coverage's & Medicare/Medicaid Guidelines.
  • Processed Medicaid authorizations for payment.
  • Prepared NC Medicaid form 5020 for all newborns born to mothers with valid NC Medicaid to ensure the baby was enrolled.
  • Gathered documents to send to insurance, Medicaid, and Medicare to get insulin pumps and supplies approved for customers.
  • Obtained authorization from all commercial, Medicaid, Medicare, and workers compensation insurances for the requested pain management surgery.
  • Participate in weekly staffing with clinicians and quality assurance team to ensure all Medicaid billing guidelines were being followed.
  • Set policies and procedures in place to maintain all prior authorizations as to diminish any loss of Medicaid revenue.
  • Required to have an extensive knowledge of Medicaid policy with regards to authorizations and their diagnosis and procedure codes.
  • Designed and maintained a filing system for outgoing authorization of Medicaid forms and incoming authorizations letters from Value Options.
  • Worked the reject report to follow up on unpaid claims for Medicaid, Medicare and Managed care patients.
  • Submitted authorizations to a Medicaid care coordinator in order to obtain services for clients that seek therapy.

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11. Medical Services

high Demand
Here's how Medical Services is used in Authorization Specialist jobs:
  • Verify insurance information for patient coverage and benefits pertaining to medical services designated for primary care physician office.
  • Initiated authorizations of medical services for patients with Medicare and Medicaid coverage.
  • Processed incoming and outgoing patient referrals for medical services.
  • Interpreted medical services and benefits for billing to workers comp.
  • Processed pre-authorizations for medical services, drafted determination letters, and other duties as assigned.
  • Completed accurate and timely referrals and pre-authorizations for medical services.
  • Processed reauthorization requests for medical services and equipment within clients turnaround time and based on medical necessity and payer guidelines.
  • Review Insurance payor guidelines and requirements to obtain authorization of services from insurance payers formedical services.

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12. Durable Medical Equipment

high Demand
Here's how Durable Medical Equipment is used in Authorization Specialist jobs:
  • Comply with all applicable local/state/federal regulations related to the medical device and durable medical equipment industries.
  • Submitted requests for authorization of durable medical equipment necessary to the client for increased independence.
  • Processed authorization for oxygen and durable medical equipment using AS400 database.
  • Obtained authorizations for high dollar durable medical equipment.
  • Organize or work with detailed office or warehouse personnel to ensure shipment of durable medical equipment and supplies.
  • Assist in the preparation of paperwork to provide pediatric patients durable medical equipment suited to their needs.
  • Worked on monthly hold reports for Durable medical equipment and supplies.
  • File PCW/HHA/Duty sheet and Durable medical equipment orders as necessary.

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13. Veterans

high Demand
Here's how Veterans is used in Authorization Specialist jobs:
  • Assist Veterans by obtaining client information; assisting in medical appointments, determining eligibility, and maintaining database.
  • Received Veterans demographics, supplemental documents and authorizations of procedures.
  • Review and enter complex authorizations for Veterans and medical providers.
  • Documented outbound communication from providers and veterans.
  • Profiled and completed authorizations for veterans.
  • Billed and approve authorizations for Veterans
  • Research, built, correct and edit all authorization that are approved and denied from the Veterans Administration.
  • Call veterans if needed to update any missing information as well as answering any unresolved issues.
  • Educate providers and veterans on what the VA Choice Program is and why we are here.
  • Build medical authorizations for Veterans seeking care outside of the VA using the Care Radius.
  • Review and create complex authorizations and referrals received from VAMC and providers for US veterans.
  • Work various ques to process medical information and authorizations for veterans throughout the nation.
  • Respond to inquiries from Veterans and providers regarding specific aspects of the VA program.
  • Worked directly with U.S. Department of Veterans Affairs on liens, psychiatric evaluations.
  • Process authorizations for Veterans seeking care outside the VA system.
  • Explain various VA insurances and guidelines to veterans and providers.
  • Assist veterans with getting the care they deserve.
  • Scheduled and followed up on appointments for veterans.
  • Improved the lives of the Veterans.
  • Reviewed and entered complex authorizations from the VA and providers to provide Veterans with hi-quality healthcare in a call center environment.

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14. Phone Calls

high Demand
Here's how Phone Calls is used in Authorization Specialist jobs:
  • Research, prioritize and respond to Utilization Management, requests via email, fax queue, and telephone calls.
  • Screen telephone calls, take messages, transfer calls and process incoming and outgoing mail.
  • Place outbound phone calls to providers, as needed, within contractual guidelines.
  • Respond to emails and phone calls from field offices and/or patient.
  • Handled all incoming phone calls and emails for the assigned caseload.
  • Answered inbound service requests and telephone calls from customers and clients.
  • Answered phone calls, made appointments and took payments by phone.
  • Delivered decisions and conducted phone calls to homeowner on denied claims.
  • Obtained appropriate prior authorizations via phone calls for upcoming admissions.
  • Answer all incoming phone calls and handles patient inquiries.
  • Verify benefits by direct phone calls and/or payer websites.
  • Maintained 98-100% audit scores for all phone calls.
  • Receive, screen, and direct telephone calls.
  • Answer phone calls and transferred to appropriate staff.
  • Assisted with answering phone calls and taking messages.
  • Scheduled appointments, answered incoming phone calls.
  • Place outreach phone calls to providers and parents in regards to payments, documents needed, and schedule changes.
  • Answered phone calls, faxes, and emails from vendors, sales reps and resellers.
  • Triaged incoming phone calls in-que.

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15. Scheduling Appointments

average Demand
Here's how Scheduling Appointments is used in Authorization Specialist jobs:
  • Perform tasks such as verifying and scheduling appointments, update/amend authorizations using CPT codes and diagnosis codes when permitted.
  • Enter Patient information into system and updating existing customer information scheduling appointments for patients with specialists and physicians within the hospital.
  • Enabled care providers to focus on patient care by scheduling appointments and preparing daily required materials/records.
  • Provided customer service for the main lab and infertility lab including scheduling appointments and specimen collection.
  • Access to multiple hospital systems to obtain inpatient registration information when scheduling appointments for surgery center.
  • Provided translation for Nurse Practitioner assessment and scheduling appointments for Vietnamese residents.

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16. Medical Necessity

average Demand
Here's how Medical Necessity is used in Authorization Specialist jobs:
  • Requested letters of medical necessity from numerous physicians in order to file appeals on denied authorization.
  • Update demographics; obtain letters of medical necessity and missing documentation from doctors.
  • Compiled clinical documentation to support the medical necessity for respiratory care.
  • Provided clinical documents to support medical necessity for additional authorizations.
  • Provide all clinical documentation needed to support medical necessity.
  • Previewed all medical documentation for accuracy and medical necessity.
  • Review all medical documentation to ensure medical necessity.
  • Reviewed medical documentation for accuracy and medical necessity.
  • Reviewed ICD9 and ICD10 codes for medical necessity, to identify urgency or the Authorization.
  • Prove medical necessity on a case-by-case basis, to assure every inpatient day is approved.
  • Determine the appropriate level of care authorized for each member based on medical necessity.
  • Specialized in verification, authorization, performed medical necessity checks, pre-register patients who were scheduled for surgery.
  • Submitted and obtained authorizations, pre-determinations and medical necessity reviews to insurance companies, including Workman Comp.
  • Get authorizations from commercial insurances in a timely manner based on medical necessity.

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17. Hipaa

average Demand
Here's how Hipaa is used in Authorization Specialist jobs:
  • Demonstrate and apply knowledge of medical terminology, high proficiency of general office procedures including HIPAA regulations.
  • Demonstrated knowledge of HIPAA by appropriately managing patient confidentiality.
  • Participate in department meetings, Attends HIPAA training and other training sessions as required.
  • Follow all HIPAA, Accreditation and Insurance guidelines during order processing.
  • Conduct all transactions with the highest industry standards for HIPAA.
  • Organize patient charts, read physician progress notes, and call insurance companies to verify patient eligibility.Exercising HIPAA regulations.
  • Input billing records in the SEDCare system HIPAA Privacy officer Teach HIPAA in new hire orientation Create and manage staff website

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18. MRI

average Demand
Here's how MRI is used in Authorization Specialist jobs:
  • Obtain prior authorization for outpatient MRI's & CT scans, verify insurance benefits, communicate with referring providers.
  • Conduct authorization for CT scans, MRI's, Mammograms, X-Rays for private insurances.
  • Perform tasks associated with authorizing MRI, CT, NM and PET examinations as needed.
  • Authorized MRI's and surgeries with insurance companies.
  • Obtain authorizations for MRI and knee injections.
  • Obtained authorizations for MRI and CAT scans.
  • Obtain authorization for CT, MRI, PET scans.
  • Authorized surgeries, CT scans, MRIs, and various therapies.
  • Obtained authorizations for MRI scans, PET scans, and Echocardiograms.
  • Obtained health insurance authorization for mri, ct and ultrasound.
  • Coordinate with insurance companies and referring doctor's office for pre authorization for MRI, CT, US, PET CTs.
  • Schedule Catheterization, MRI, CAT scan, and also spoke with patient in regards to treatment plan.
  • Obtained authorizations for injections, MRIs, Braces, and CTs using different insurance portals.
  • Obtained pre-authorization of MRIs, surgeries, and other procedures.

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19. EMR

average Demand
Here's how EMR is used in Authorization Specialist jobs:
  • Documented authorization in EMR system.
  • Provided training for all new staff members of EHR, EMR, & other computer programs used by the practice.
  • Assisted the team lead with obtaining, tracking and entering drug/chemo authorizations being entered in the EMR/PMR systems.
  • Transfer all Information from IDX to Epic EMR system I would also make medically necessary approvals/denials for authorizations.
  • Completed extensive training with Epic EMR systems to ensure patient satisfaction and efficiency.
  • Experience with computers and/or automated scheduling, EMR and/or IDX experience highly desirable.
  • Created and modified documents using Microsoft Word, Excel and EMR.
  • Utilized EMR system to access records used in submission of authorizations.
  • Documented all information into EMR (EHR) systems.
  • Updated and input patients' information into EMR software.
  • Entered patient's demographics and test results to EMR.
  • Excel, Microsoft office, EMR experience.
  • Scan necessary documents into EMR system.
  • Input information in EMR and spreadsheets.
  • Utilized several software sites including EMR to complete daily tasks in a timely manner.
  • Verify Insurance and enter all of the patients information in EMR system.
  • Maintain pt EMR accounts, answer pt calls in regards to insurance.
  • Maintain patient records Current with Medstreaming EMR

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20. Icd-9

average Demand
Here's how Icd-9 is used in Authorization Specialist jobs:
  • Verified daily billing submission report for insurances, including HCPCS codes, ICD-9 codes and modifiers.
  • Assigned appropriate ICD-9 codes to all identified diagnoses, researched and entered prescriptions as instructed.
  • Verified and obtained ICD-9 code as needed for inpatient stays.
  • Assign appropriate ICD-9 codes to all identified diagnosis.
  • Obtain specific insurance and patient demographic information, as well as ICD-9 codes.
  • Coded and posted the patient encounters in accordance to ICD-9 regulations.

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21. Hippa

average Demand
Here's how Hippa is used in Authorization Specialist jobs:
  • Position required confidentiality and follow-up of DAODAS and HIPPA privacy guidelines for the agency, and safety of all clients.
  • Adhered to clinic policies on safety and security, and practiced confidentiality and privacy protocols in accordance to HIPPA.
  • Respected and maintained privacy of clients, assuring client confidentiality at all times while following HIPPA procedures.
  • Followed all HIPPA and OSHA laws on procedures and policies concerning confidentiality and PPE.
  • Facilitate client intake process following DAODAS and HIPPA guidelines.
  • Gained required knowledge about Medical Laws/ HIPPA requirements.
  • Maintained detailed HIPPA compliant records of pre authorizations and insurance benefits.
  • Adhere to HIPPA and insurance reimbursement guidelines.

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22. Front Desk

average Demand
Here's how Front Desk is used in Authorization Specialist jobs:
  • Communicate effectively with front desk coordinators and therapists to assist in resolving patient questions and concerns about statements and charges.
  • Helped with filing and front desk work, such as making of appointments, verifying insurance and greeting consumers.
  • Front desk receptionist duties including patient greeting and answering telephone for all customer and office associated calls.
  • Provide estimated patient responsibility to front desk staff for patient follow up.
  • Delegated the individuals at the front desk department of their daily tasks.
  • Cross train on front desk procedures, including opening and closing.
  • Act as back up for front desk when necessary
  • Cover the front desk and switchboard when needed.
  • Front Desk administration support on a weekly basis.
  • Covered Front Desk personnel for lunch break.
  • Back for front desk/ check in and check out.
  • Answer phones, front desk duties.
  • Assist at front desk daily and as needed.Skills UsedCustomer service, compassion for patients suffering from pain.
  • Monitor billing and collection :patient account management .front desk coverage.
  • Managed front desk for physical therapy * Checked in patients * Received co-payments, office visit payments

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23. Authorization Request

average Demand
Here's how Authorization Request is used in Authorization Specialist jobs:
  • Submit authorization requests if required and provide supporting documentations for those prior authorizations to be approved or denied.
  • Submit authorization request to adjusters and utilization review departments, along with medical documentation and RFA.
  • Communicate review decisions effectively and resolves inquires related to status of authorization requests.
  • Initiate authorization requests for various insurance based on the completed paperwork received.
  • Process authorization requests and referral requests in the online medical management system.
  • Submitted all authorization request forms and all other required documentation.
  • Researched and prepared authorization requests for insurance company approval.
  • Apply clinical criteria to prior-authorization requests consistently and accurately.
  • Process authorization request* Follow up on authorizations* Verify patients eligibility
  • Gather supporting documentation for authorization requests.
  • Tracked outstanding service authorization requests.
  • Handled multiple patient prior authorization requests at a time in an efficient and accurate manner utilizing Home Care Home Base system.
  • Submit, track, and review authorization requests for clients of the Children s Service School Based Program.
  • Submitted prior authorization requests to the correct funding sources and followed up on those authorization requests.
  • Communicate with the MCO s for status updates on all outstanding and pending Authorization Requests.
  • Verify insurance for both in and out of network benefits, submit authorization requests.
  • Confirmed the receipt of the authorization request within 48 hours of the submission.
  • Maintained consistent follow up on status of all prior authorization requests.
  • Type and forward authorization requests to eleven different mental health agencies.
  • Process Secondary Authorization Requests (SAR) uploaded into CR.

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24. HMO

average Demand
Here's how HMO is used in Authorization Specialist jobs:
  • Verified and interpreted insurance benefits for HMO, PPO, EPO, POS, IPA, and Worker's Compensation.
  • Submitted authorization and followed up on all insurance Payers including Medicare, Medicaid, HMO's and PPO's.
  • Secured authorizations (all insurances, MediCal, CCS, HMO, PPO etc.)
  • Request authorizations from insurance companies for procedures for all of our HMO patients.
  • Verified member eligibility and benefits with various insurances, (HMO, PPO, Commercial, Supplemental insurances.
  • Request prior authorization from HMO medical group, ppo insurances, obtain pre-certification for various services rendered.
  • Maintain knowledge of HMO, PPO, Medi/Medi, and Workers Comp Medical insurance processing polices.
  • Obtained aithorizations for all hmo insurances for follow up appointments and surgeries.
  • Worked with all insurances including but not limited to HMOs, PPOs
  • Obtained authorization from various insurance carriers; Private insurance/HMO/ Workers" Comp Surgery/PT/Chiro/Acupuncture/MRI/CT Scan.

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25. Icd-10

average Demand
Here's how Icd-10 is used in Authorization Specialist jobs:
  • Work with standard coding systems including standard medical taxonomy, ICD-10, and the Health Care Common Procedure Coding System.
  • Converted all ICD -9 Codes to new ICD-10 codes for all patients billed after 10/1/2015.
  • Interpreted medical reports to apply appropriate ICD-10, CPT codes.
  • Assign coding profiles (CPT & HCPCS Level II) and diagnosis codes (ICD-9/ICD-10).
  • Check ICD-10 codes, to make sure codes are valid with diagnoses.
  • Assign billing codes ICD-9/ICD-10 and/or CPT/HCPC code.
  • Well versed in CPT Codes and ICD-10.
  • Verify CPT Codes/ICD-10 CODES point of contact for questions and acting team lead.

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26. Authorization Process

average Demand
Here's how Authorization Process is used in Authorization Specialist jobs:
  • Review the insurance verification and complete the authorization process within established time frames.
  • Assisted team members with clinical interpretation of patient's record during re-authorization process.
  • Worked closely with staff concerning this authorization process.
  • Helped streamline the authorization process to allow for accuracy in our billing process, which resulted in higher-revenues for the clinic.
  • Assisted Qualified Professionals, LCSW's, MSW's, with understanding the authorization process and document requirements.
  • Demonstrate a thorough knowledge of medical insurance coverage & the authorization process for each specific study.
  • Act as the point of contact for issues of moderate complexity relative to the authorization process.
  • Input call tracking notes with each call received or made throughout the prior authorization process.
  • Educate employees from other departments regarding the central authorization process.
  • Assist customer service with RMA authorization processing.
  • Market authorization services to smaller offices to help assist with the authorization process.

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27. Physician Offices

average Demand
Here's how Physician Offices is used in Authorization Specialist jobs:
  • Provide information to referring/rendering physician offices regarding network imaging centers and other issues related to NIA covered services.
  • Obtain initial and authorization extensions from ordering physician offices and/or health plans.
  • Assisted physician offices and patients with contract benefits and referral authorizations.
  • Contacted referring physician offices regarding patient information or results.
  • Assured approval/denials were communicated to physician offices.
  • Served as a liaison for several physician offices ans scheduled appointments for patients at area hospitals.
  • Interact with patients and referring physician offices in a positive, professional manor.
  • Respond to inquiries from physician offices, hospitals, and patient.
  • Work closely with physician offices to collect and input updated information.
  • Answer calls from other physician offices, hospitals and patients.
  • Coordinate necessary referrals and pre-authorizations with primary care physician offices and insurances seamlessly.
  • Worked along side physician offices to complete insurance authorizations.
  • Served as a liaison for several physician offices Worked closely with hospital staff scheduling patients for various appointments.
  • Receive pre-authorization requests for designated ASO accounts from referring physician offices via telephone, utilizing the Informa system.

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28. Physical Therapy

average Demand
Here's how Physical Therapy is used in Authorization Specialist jobs:
  • Request prior authorization from insurance and primary care doctors for all physical therapy, chiropractic, pain management procedures and DME.
  • Requested authorization for DME, imaging, physical therapy, acupuncture.
  • Secure authorizations for office visits, physical therapy referrals, diagnostic tests, non-formulary prescriptions, durable medical equipment.
  • Supervised the physical therapy authorizations department, researched and problem solved allauthorization issues.
  • Assisted Intake coordinator arranging ancillary care for home healthcare for wound care, physical therapy, and IV infusion therapy.
  • Follow up on Insurance and patient aging Call insurance carriers to verify and obtain patient information to start physical therapy.

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29. Health Information

low Demand
Here's how Health Information is used in Authorization Specialist jobs:
  • Assemble information concerning patient electronic health information.
  • Take appropriate measures to comply with HIPAA regulations to protect privacy of Veterans health information.
  • Comply with HIPPA regulations to protect privacy of Veteran's health information.
  • Maintain HIPAA standards and ensure confidentiality of protected health information.

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30. Authorization Data

low Demand
Here's how Authorization Data is used in Authorization Specialist jobs:
  • Received and entered all funding and authorization data into agency's integrated billing system.
  • Managed access authorization database Em-Pact Created and updated access authorization files for V.C.

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31. Patient Accounts

low Demand
Here's how Patient Accounts is used in Authorization Specialist jobs:
  • Review insurance information in patient accounts and make necessary corrections.
  • Provide customer service both on the telephone and in the office for all patients and authorized representatives regarding patient accounts.
  • Verified all in and outpatient accounts with the corrected CPT Codes and verified authorization and initiated all schedule hospital appointments.
  • Collected credit card payments done over the phone from patients as well as posting to patient accounts.
  • Obtained and confirmed patient information in accordance with HIPAA; continuously and effectively updated new patient accounts.
  • Manage patient accounts for processing, contact doctor's office for medical documents and diagnoses.
  • Reviewed delinquent patient accounts and prepared them for transfer to a collection agency.
  • Reviewed patient accounts for credits and processed refunds to insurance companies and patients.
  • Managed the patient accounts for all the clinics in New Hampshire.
  • Conducted Audits of patient accounts to assure complete and proper payment.
  • Post insurance payer denials on patient accounts.
  • Post charges and credits to patient accounts.
  • Provide instructions to patients regarding cardiac procedures Taking co-payments and monies regarding patient accounts
  • Review patient accounts for possible credits, due to overpayment.

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32. Outbound Calls

low Demand
Here's how Outbound Calls is used in Authorization Specialist jobs:
  • Make outbound calls to physician office's to obtain medical documentation for patients so respiratory items can be approved by insurance.
  • Make outbound calls to engage members and/ or providers to verify clinical information.
  • Make outbound calls in order to get missing information or reschedule patients.
  • Place outbound calls to Veterans using professional and courteous service skills.
  • Make outbound calls to Veterans and Providers as needed.
  • Make outbound calls to providers as warranted.
  • Assist customers and contractors through inbound/outbound calls.
  • Follow up with outbound calls.
  • Make outbound calls to Providers and patients to schedule consultations with specialists such as, Cardiology, Gastroenterology, Endocrinology etc.

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33. Accurate Documentation

low Demand
Here's how Accurate Documentation is used in Authorization Specialist jobs:
  • Conduct research to ensure accurate documentation of the Veteran s clinical information.
  • Maintained accurate documentation in NextGen.
  • Selected Contributions: Conducting research to ensure accurate documentation of the patient's clinical information.
  • Maintained detailed and accurate documentation of all prior authorization approvals and denials.
  • Research and resolve issues while maintaining accurate documentation.
  • Maintained complete and accurate documentation.

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34. Patient Service

low Demand
Here's how Patient Service is used in Authorization Specialist jobs:
  • Initiated authorization requests for Kaiser outpatient services in accordance with the prior authorization list.
  • Verify health insurance eligibility coverage and provide estimates for inpatient and outpatient services.
  • Worked directly with various insurance companies for authorizations of outpatient services.
  • Verify insurance benefits and obtain referral or authorizations for outpatient services.
  • Registered patients for outpatient and inpatient services for several clinics.
  • Obtain insurance authorizations for patients for medical outpatient services.
  • Obtain authorization for the services provided during Inpatient stay, and for outpatient services in timely manner.
  • Performed billing and coding procedures for emergency room, impatient and outpatient services.
  • Promoted from Patient Service Representative to current position after one year of employment.
  • Scheduled patient services for physicians, clinics and transport.
  • Follow up in a timely fashion to ensure proper processing of all prior authorizations needed for patient services.

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35. Customer Information

low Demand
Here's how Customer Information is used in Authorization Specialist jobs:
  • Gathered and verified all required customer information for tracking purposes.

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36. Surgical Procedures

low Demand
Here's how Surgical Procedures is used in Authorization Specialist jobs:
  • Obtained verification of insurance coverage and authorizations for clinical visits and surgical procedures for patients.
  • Obtained authorizations for surgical procedures, diagnostic testing, medications, and durable medical equipment.
  • Obtained Authorizations for Radiology Scans, Radiation Therapy, Biopsies and Surgical Procedures.
  • Obtained and processed all referrals, authorizations and pre-certifications for patients requiring ancillary testing and/or surgical procedures to ensure timely reimbursement.
  • Schedule patients for surgical procedures, radiology testing, referrals, pre op testing.
  • Processed pre-authorizations for surgical procedures, verified insurance eligibility and advised patients of their benefits and out of pocket expense.

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37. Computer System

low Demand
Here's how Computer System is used in Authorization Specialist jobs:
  • Enter specialty equipment orders and customer demographics into the computer system.
  • Entered and updated Clinical Information into Computer System.
  • Process referrals for CCS, Medical, and ETAR with the utilization of EHR and STAR computer systems.
  • Created and processed all doctor's orders from computer system and mailed them out for MD signatures.
  • Job required the utilization of a variety of in-house computer systems and tools to execute daily responsibilities.
  • Entered data into computer system (CMHC/BUI) of outgoing authorization of Medicaid and incoming authorizations letters.
  • Created 485's and doctor's orders into computer system.
  • Entered patient's medication into computer system.
  • Enter physician orders into computer system.
  • Gathered pertinent patient information to submit pre-authorization forms to insurance companies and recording them in company computer system upon return.
  • Entered all pertinent information in the Dataline computer system including policyholder information, authorizations & expiration dates.
  • Call back providers with pre-certification numbers as needed and document completed pre-certifications in computer system.
  • Input data into Meditech, MedSurg, Allegra, MedFax, and other intra-office computer systems.
  • Verify patients insurance information Obtain authorizations Pre-register patients Update information in computer system

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38. Special Projects

low Demand
Here's how Special Projects is used in Authorization Specialist jobs:
  • Assist Housing Coordinator with special projects, intakes, apartment inspections and other Mental Health Residential responsibilities as needed.
  • Worked in special projects such as New Born authorization requests and adding them into the Care Radius System.
  • Assist Managed Care Department and Director of Revenue Services with special projects, back up billing staff.
  • Top 3 Percent of class, Selected for Special projects such as Return Mail and Lead roles.
  • Complete special projects with case management nurses and input authorizations into authorization system (IKA).
  • Support and assist with service desk tickets and work on special projects as needed.
  • Assist administrative staff with special projects and routine office duties.
  • Assisted physician with special projects and bi-monthly reports.
  • Provide assistance to department as needed on special projects
  • Headed up special projects for supervisor.
  • Created spread sheets for special projects.
  • Assist staff with verifying and authorizing insurance eligibility and benefits Oversee and assist with special projects within the billing department.

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39. Patient Demographics

low Demand
Here's how Patient Demographics is used in Authorization Specialist jobs:
  • Maintained accurate and up to date files that included insurance verification and patient demographics.
  • Managed patient profiles daily to ensure current patient demographics and insurance information.
  • Reviewed patient demographics, verify eligibility & benefits.
  • Updated registration on patient demographics and insurance information.
  • Worked with billing on emergencies set ups and followed up with referral source on obtaining patient demographics and documentation.
  • confirmed patient demographics on established patients.
  • Key Projects: Collected all patient demographics with 100% accuracy.

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40. External Customers

low Demand
Here's how External Customers is used in Authorization Specialist jobs:
  • Communicated extensively with internal and external customers and Vendors on account updates and shipments.
  • Interfaced with government representatives, major sub-contractors, and internal/external customers.
  • Provided support to internal and external customers.
  • Designed benefit summaries and payment recap reports to be sent to internal and external customers.
  • Provide internal and external customers with speedy resolution to problems, issues or concerns.
  • Interacted with internal and external customers on a daily basis.

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41. RN

low Demand
Here's how RN is used in Authorization Specialist jobs:
  • Investigated returned prior authorizations, and ran weekly expiring authorizations reports and tracked existing prior authorizations via Excel program.
  • Completed statistical budgetary data entry and analysis verifying the costs of line items in compliance with government specifications.
  • Prioritize incoming authorization requests for urgent and non-urgent triage to maintain compliant turn-around times with decision making.
  • Prepared medical record packets for attorneys, insurance companies and workers compensation inquiries.
  • Reviewed benefits with each new patient and answered any concerns regarding their responsibility.
  • Communicated all physician and customer service issues to branches internally and externally.
  • Assist in the implementation of internal and external quality assurance activities.4.
  • Interviewed and confirmed Section 8 voucher participants eligibility for government assistance.
  • Contacted providers to obtain information concerning patient claim or prior authorization.
  • Verified insurance coverage via telephone or internet, obtain benefit information.
  • Received incoming calls to reevaluate denial decisions and possibly overturn them.
  • Streamlined out patient authorization department and improved patient return rate.
  • Processed and tracked return authorizations of customer and vendor returns.
  • Processed international return authorizations originating from outside the United States.
  • Issued return material authorizations for returned damaged hard drives.
  • Assist Quality Control department with addressing consumer and compliance concerns
  • Worked with families on answering financial concerns regarding benefits.
  • Process and prepare business or government insurance authorization forms.
  • Reviewed customer financial information with credit bureaus and internally.
  • Gathered and prepared internal and external managed care referrals.

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42. Billing Department

low Demand
Here's how Billing Department is used in Authorization Specialist jobs:
  • Coordinated with the Billing Department, Treatment Team, and patient families regarding insurance information and changes.
  • Assist billing department with posting charges, claims, and other duties when requested by administrator.
  • Worked closely with all therapists and billing department to insure non-stop patient treatment and payment.
  • Worked along with the clinic managers, schedulers and billing department to prevent losses.
  • Faxed EOB to billing department at the end of the day.
  • Assist the Billing Department with collections.
  • Assist billing department with claims.
  • Obtained authorization and referrals for patient appointments Worked in harmony with the billing department to provide correct patient insurance information.

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43. Medical Referrals

low Demand
Here's how Medical Referrals is used in Authorization Specialist jobs:
  • Process medical referrals from VA and providers, attach medical documentation to veterans authorizations for payment processing.
  • Document the transmission of medical referrals through the use of various software programs.
  • Document the transmission of medical referrals to a facility or network provider.
  • Process medical referrals for veterans.Attaching medical documentation to the correct medical file.
  • Enter the correct cpt code and ICD-10 codes for medical referrals.

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44. Outpatient Procedures

low Demand
Here's how Outpatient Procedures is used in Authorization Specialist jobs:
  • Ensured payment for outpatient procedures by verifying benefits with insurance providers.
  • Process all incoming authorization requests for inpatient and outpatient procedures.
  • Scheduled and authorized outpatient procedures for three separate hospitals.
  • Obtain all authorization and referrals for all outpatient procedures.
  • Obtain benefits and authorization for inpatient and outpatient procedures by working with specialists secretary's and other designated personal.
  • Schedule laboratory testing and outpatient procedures and answer patient questions regarding their appointments and tests.

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45. Appropriate Measures

low Demand
Here's how Appropriate Measures is used in Authorization Specialist jobs:
  • Take appropriate measures to comply with HIPAA.

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46. Medical Procedures

low Demand
Here's how Medical Procedures is used in Authorization Specialist jobs:
  • Coded medical procedures accurately in the system, maintained veteran files and information.
  • Obtained authorizations for medical procedures, physical therapy, Durable Medical Equipment, workers comp, and auto injuries.
  • Pull referrals, and authorizations for medical procedures as required.
  • Assist providers with authorization for medical procedures and DME items.
  • Prepped patients prior to having medical procedures.
  • Obtained medical pre-certification and authorization for medical procedures.

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47. Authorization Forms

low Demand
Here's how Authorization Forms is used in Authorization Specialist jobs:
  • Complete prior authorization forms with non-clinical information and provide status updates for providers opted into this service offering.
  • Complete electronic prior authorization forms on behalf of the long term care facility.
  • Obtained and completed proper prior authorization forms.
  • Completed Prior Authorization forms with patient and physician demographics Notified the provider of the appeals process if prior authorization is denied.
  • Ensured Prior Authorization Forms contained correct clinical information in both the "follow-up" and the "same-day" processes.

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48. Diagnosis Codes

low Demand
Here's how Diagnosis Codes is used in Authorization Specialist jobs:
  • Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered.
  • Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered.
  • Assigned additional diagnosis codes based on specific clinical findings in support of existing diagnoses.
  • Communicated with nurse care managers providing HCPCT codes and diagnosis codes in order to obtain proper authorization.
  • Collect any clinical information such as lab values, diagnosis codes, etc.
  • Input procedure codes and diagnosis codes for each encounter form.

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20 Most Common Skill for an Authorization Specialist

Insurance Companies30.5%
Medical Records9.8%
Customer Service6.6%
Patient Care4.7%
Clinical Staff4.6%
Data Entry4.6%
CPT4.6%
Input Insurance Authorization4%

Typical Skill-Sets Required For An Authorization Specialist

RankSkillPercentage of ResumesPercentage
1
1
Insurance Companies
Insurance Companies
24.4%
24.4%
2
2
Medical Records
Medical Records
7.8%
7.8%
3
3
Customer Service
Customer Service
5.3%
5.3%
4
4
Patient Care
Patient Care
3.8%
3.8%
5
5
Clinical Staff
Clinical Staff
3.7%
3.7%
6
6
Data Entry
Data Entry
3.7%
3.7%
7
7
CPT
CPT
3.7%
3.7%
8
8
Input Insurance Authorization
Input Insurance Authorization
3.2%
3.2%
9
9
Procedure Codes
Procedure Codes
3.1%
3.1%
10
10
Medicaid
Medicaid
2.9%
2.9%
11
11
Medical Services
Medical Services
2.6%
2.6%
12
12
Durable Medical Equipment
Durable Medical Equipment
2.5%
2.5%
13
13
Veterans
Veterans
2.4%
2.4%
14
14
Phone Calls
Phone Calls
2.3%
2.3%
15
15
Scheduling Appointments
Scheduling Appointments
1.8%
1.8%
16
16
Medical Necessity
Medical Necessity
1.6%
1.6%
17
17
Hipaa
Hipaa
1.5%
1.5%
18
18
MRI
MRI
1.4%
1.4%
19
19
EMR
EMR
1.3%
1.3%
20
20
Icd-9
Icd-9
1.2%
1.2%
21
21
Hippa
Hippa
1.2%
1.2%
22
22
Front Desk
Front Desk
1.1%
1.1%
23
23
Authorization Request
Authorization Request
1%
1%
24
24
HMO
HMO
0.9%
0.9%
25
25
Icd-10
Icd-10
0.9%
0.9%
26
26
Authorization Process
Authorization Process
0.8%
0.8%
27
27
Physician Offices
Physician Offices
0.8%
0.8%
28
28
Physical Therapy
Physical Therapy
0.8%
0.8%
29
29
Health Information
Health Information
0.8%
0.8%
30
30
Authorization Data
Authorization Data
0.8%
0.8%
31
31
Patient Accounts
Patient Accounts
0.8%
0.8%
32
32
Outbound Calls
Outbound Calls
0.8%
0.8%
33
33
Accurate Documentation
Accurate Documentation
0.7%
0.7%
34
34
Patient Service
Patient Service
0.7%
0.7%
35
35
Customer Information
Customer Information
0.7%
0.7%
36
36
Surgical Procedures
Surgical Procedures
0.7%
0.7%
37
37
Computer System
Computer System
0.6%
0.6%
38
38
Special Projects
Special Projects
0.6%
0.6%
39
39
Patient Demographics
Patient Demographics
0.6%
0.6%
40
40
External Customers
External Customers
0.6%
0.6%
41
41
RN
RN
0.5%
0.5%
42
42
Billing Department
Billing Department
0.5%
0.5%
43
43
Medical Referrals
Medical Referrals
0.5%
0.5%
44
44
Outpatient Procedures
Outpatient Procedures
0.5%
0.5%
45
45
Appropriate Measures
Appropriate Measures
0.5%
0.5%
46
46
Medical Procedures
Medical Procedures
0.5%
0.5%
47
47
Authorization Forms
Authorization Forms
0.5%
0.5%
48
48
Diagnosis Codes
Diagnosis Codes
0.4%
0.4%

19,770 Authorization Specialist Jobs

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