Authorization Specialist

PURPOSE STATEMENT   

Complete the necessary tasks to verify insurance benefits, validate authorization requirements, and obtain authorization required for services ordered by or performed at Western Missouri Medical Center. Will be required to complete referrals and authorizations for both WMMC Knob Noster and Concordia clinics.

ESSENTIAL FUNCTIONS  

• Verify insurance benefits for the patient. 
• Work directly with payer to validate and when necessary, submit to obtain authorization for services on behalf of the patient. 
• Follow up on denials related to authorization issues. 
• Perform pre-registration duties as requested. 
• Obtain correct patient demographic and insurance information. 
• Determine patient’s financial responsibility (i.e. co-pays and deductibles). 
• Collect and enters accurate MSP information for Medicare patients. 
• Demonstrate competency with equipment, utilizes supplies and equipment properly. 
• Demonstrate behaviors which promote professionalism. 
• Work without constant supervision, meets deadlines, makes decision based on relevant facts. 
• Maintain a positive attitude and behaviors in keeping with the Medical Centers Mission, Vision and Value Statement of Behavior. 
• Promote and instills the teamwork concept by assisting co-workers when appropriate. 
• Collaborate with other internal customers, providers, as appropriate, to accomplish the work of the department. 
• Consistently follow established Departmental, Human Resources and Hospital Policies and Procedures. 
• Demonstrate willingness to accept additional assignments. 
• Maintain regular and predictable attendance. 
• Perform other essential duties as assigned. 

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS 

• High school diploma or equivalent. 
• Typing skills of 45+ WPM. 
• Previous clerical experience. 
• Great customer services skills. 
• Previous medical support services experience. 
• Must be self-motivated and have the ability to work within the established policies, procedures and practices prescribed by the hospital/clinic. 

PHYSICAL/MENTAL REQUIREMENTS 

• Must be able to sit and stand, intermittent 8 to 10 hours a day. 
• Must be able to use standard office equipment, including the telephone and computer keyboard. 
• Continuously works under pressure of near 100% accuracy while meeting inflexible deadlines. 
• Continuously utilizes manual/bi-manual dexterity, near vision, speech, and hearing. 
• Frequently stands, walks, sits and utilizes eye/hand coordination and color definition. 
• Occasionally reaches above shoulder, regularly required to lift and/or carry up to 40 lbs. 
• Occasionally walks on uneven surfaces.