Authorization Specialist - IRMC Physician Group - Full Time

Essential Duties and Responsibilities

In this role you will be:

• Utilizing an understanding of medical insurance and the clinical policies that determine the authorization protocols for each health plan.


• Identifying all appointments and procedures for assigned departments that require authorization by monitoring the schedules, system reports, and dashboards.


• Identifying the referral and authorization requirements of the patients; insurance plans by using various online resources according to department workflows.


• Demonstrating knowledge of insurance carrier guidelines, clinical policies, and state guidelines pertaining to referrals and prior authorization.


• Verifying insurance eligibility and benefits and updating the patient’s insurance information as necessary.


• Completing prior authorizations in a timely manner according to department guidelines and workflows.


• Communicating clearly and effectively with patients, physicians, office staff, and managers to resolve issues that may result in a denied or delayed authorization request.


• Demonstrating the ability to request, prepare, and recognize the documentation required to support the medical necessity for the service being authorized.


• Providing the supervisor and manager with immediate feedback on issues affecting workflow, reimbursement, and customer service.


• Ensuring that appropriate and accurate information is entered in the patient account.


• Collaborating with team members to meet department deadlines and benchmarks.

OTHER DUTIES

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

QUALIFICATIONS

Required:

• EDUCATION: High school diploma, medical terminology, vocational/technical school diploma preferred


• EXPERIENCE:
  
  
  
  • 2-4 years related clinical experience preferred
  
  
  • Experience with standard office equipment and machines required
  
  
  • Microsoft Office Suite experience required
  
  
  
  


• LICENSURE/CERTIFICATION: N/A

Skills:

• Communication | Critical thinking | Teamwork | EMR | Time management | Problem-solving | Attention to detail