H

Authorization Specialists

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Job Description - Authorization Specialists

Essential Functions



  • Monitor the authorizations of upcoming cases on physician’s calendars ensuring authorization for office visits is obtained in a timely and accurate manner.

  • Document authorizations and progress of authorizations in the patient's chart. Enter information within case management.

  • Must be able to communicate effectively with physicians, patients, and co-workers and be capable of establishing working relationships with both internal and external customers.

  • Work with the department manager to respond to and reduce complaints timely and professionally.

  • Ensure strict confidentiality of all health records, member information and meet HIPPA guidelines.


Required Skills/ Abilities



  • Effective in organization and billing requirements and authorization process

  • Medical terminology.

  • Skill in using computer programs and applications including Microsoft/ Excel, Microsoft Word and Outlook.

  • Knowledge of insurance plans and procedures.

  • Adherence to all policies and procedures, including standards for safety, attendance, punctuality, and personal appearance.

  • Must be able to establish and maintain effective working relationships with management and peers.

  • Ability to multitask in a fast-paced environment. Must be detailed oriented with strong organizational skills.

  • Ability to work independently and demonstrate the ability to analyze data


Physical and Mental Demands



  • Prolonged periods of sitting at a desk and working on a computer.

  • Manual dexterity using a calculator, keyboard, photocopier, and other office equipment.

  • Lifting of up to 15 pounds unassisted. Frequent bending, reaching, and repetitive hand movements standing, walking, squatting and sitting.

  • Ability to view computer screens for long periods of time.


Duties/ Responsibilities



  • Contact the insurance company to see if authorization is needed for injections, images, in-office procedures, and visits.

  • Obtain and document the authorization and benefit details and attach the information to claim for said dates of service.

  • Work with Medical Assistants and advise them of the status of authorization.

  • Maintain copies of the requests and the results by reference number and proof documents.

  • Perform related work as required and other projects and duties as assigned.

  • Assist in the insurance verification process as well as requesting referral authorization.

  • Contact patients to obtain accurate insurance information.

  • Participate in educational activities and attend monthly staff meetings.

  • Maintain real-time authorization chats via Athena and Outlook.

  • Responsible for medication sign out, order requests, and claim review.

  • Orders, receives, and maintain inventory of drugs and ensures their security within the facility.

  • Restock, label, collect, dispense and maintain inventory/ submission requests for medications.

  • Keeping track of follow ups and schedule patients accordingly.

  • Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue.

Original job Authorization Specialists posted on GrabJobs ©. To flag any issues with this job please use the Report Job button on GrabJobs.
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