Authorization Specialist

Education: High School Diploma required.

Experience: Two (2) years experience in hospital and/or physician billing/pre-authorization or insurance verification. Demonstrated knowledge of health insurance plans including: Medicare; Medicaid, HMOs; and PPOs required. Familiarity with electronic health records (E.H.R.) and documentation requirements and accessibility. Knowledge of online insurance eligibility and insurance verification systems.

Licensure/Certification/Registration: Medical Terminology certification preferred. Certification or Associate degree in ICD-10-CM/ICD-10-PCS; CPT, HCPCS preferred Certified Health Access Associate credential preferred

Duties and Responsibilities: Collaborates with designated clinical contacts that require escalation to peer-to-peer review. 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. Educate and counsel patients on their insurance coverage and explain payment options that are available to them. Work with front line staff to ensure collections are secured at time of presentation. Always displays exemplary core customer service skills. Consistently display effective verbal and written communication skills. Proficient understanding and use of technology/PC skills required. Work well in a fast-paced environment; efficiently organize work and maintain a high level of accuracy and productivity. Complete other duties as assigned by department leadership.