Authorization Specialist

Senior PsychCare is hiring for an Authorization Specialist.  The position is primarily responsible for obtaining required pre-authorizations and helping to process referrals for all services accurately and timely.  

 
ESSENTIAL FUNCTIONS: 

• Prioritize incoming authorization requests according to urgency 

• Initiate, verify, and complete procedure authorization/referral process 

• Resolves day-to-day issues pertaining to pre-authorization, as needed 

• Monitor provider network status 

• Obtain authorization by fax, payer website or by phone and follow up regularly on pending cases. 

• Notify appropriate departments for approvals and denials 

• Initiate and assist with appeals for denied authorizations 

• Effectively maintain, monitor, and update payer medical policy guidelines to manage authorization requirements 

• Request, review, and submit necessary patient documentation as needed to ensure approval of authorization  

• Collaborate with healthcare providers and insurance companies to resolve any issues related to prior authorization 

• Stay current with changing insurance policies and regulations 

• Effectively utilizes ICD 10, CPT, modifiers and/or other codes according to coding guidelines when requesting Authorizations 

• Communicates effectively with provider and/or all appropriate parties regarding missing information such as CPT, diagnoses codes, documents, clinical reports, etc. to ensure proper authorization processing 

• Communicates effectively with other departments regarding changes and/or updates with patient accounts and status 

• Manages the status of accounts and identify inconsistencies 

• Responds to billing inquiries 

• Uses downtime efficiently; is aware of team members workload 

• Makes recommendations on workflow improvement as needed 

 
KNOWLEDGE, SKILLS, AND ABILITIES: 

• Knowledge with in and out of network insurances, insurance verification, and process for prior authorization 

• Familiarity with ICD-10 and CPT codes and procedures 

• Ability to review and understand patient medical documentation 

• Ability to independently identify and understand medical necessity requirements 

• Task-oriented and organizational skills; ability to complete tasks timely 

• Detail-oriented focus; being careful about detail and thorough in completing work tasks 

• Ability to work independently and as a team 

• Ability to adapt with flexibility 

• Effective communication skills (written/verbal) 

 
EDUCATION AND EXPERIENCE: 

• High school diploma or GED 

• Three (3) years authorizations experience with Medicare/Medicaid MCO’s (Behavioral Health experience Preferred) 

• Strong working knowledge of insurance coverages and billing processes. 

• Experience with basic desktop software including Microsoft Office