Authorization and Appeals Specialist

osition Summary 

The Authorization/Appeal Specialist is responsible for filing appeals for all authorization denials on the Case Processing team and training and back up all the Authorization Coordinators on the Case Processing team.

Essential Duties and Responsibilities

The essential functions include, but are not limited to the following:

• File appeals on all authorization that have been denied
• Start and follow up on the insurance authorization process
• Train and support Authorization Coordinators 
• Create medical documents
• Update patient files with relevant information
• Communicate with insurance companies by fax, email and telephone
• Effective communication with patients, sales team and corporate staff regarding the status of the patient’s authorization
• Willing to support all members of the team
• Comply with all HIPAA and privacy regulations
• Adhere to laws and best practices in regards to dealing with patients and patient data
• Perform other job-related duties as assigned

Minimum Qualifications (Knowledge, Skills, and Abilities)

• High School Diploma or GED required 
• MS Office experience, minimum of six months required
• Data entry skills, minimum of six months required
• Basic medical terminology, minimum of six months required
• Excellent telephone skills, minimum of six months  required
• Verbal and written communication skills, required
• Able to work in a team environment, required
• Medical documentation review,  minimum of six months required 
• Previous prior authorization experience, minimum of six months required 
• Advanced knowledge of Medicare, Medicaid and commercial health insurance, required
• Experience working in a healthcare setting, required  
• Attention to detail, required 
• Critical thinking skills, required 

Physical Demands and Work Environment 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions.

• Must be able to work onsite at our corporate headquarters in Maryland Heights, MO
• Must be able to work in an office setting, use a computer, keyboard and mouse for the majority of the shift and be able to communicate on the telephone
• Must be able to work the scheduled 8 hour shift Monday-Friday