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