Authorization Specialist

JOB DESCRIPTION

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 the provider and/or all appropriate parties regarding missing information, such as CPT, diagnosis 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 identifies 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 of in and out of network insurance, insurance verification, and the 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 manner  
• 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 Managed Care Plans MCO’s (Behavioral Health experience preferred)  
• Strong working knowledge of insurance coverages and billing processes.  
• Experience with basic desktop software, including Microsoft Office