Summary: The primary goal of an Authorization Specialist is to follow up on retrieval of authorizations for either initial setup or re-authorizations on equipment or services from the insurance companies.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
- Run and work held billing reports to resolve accounts holding that require follow up completed with timely filing limits of the insurance company.
- Run reauthorization daily reports to determine the patients who need to be processed.
- Retrieve any documentation required to obtain the initial or re-authorization from the insurance companies, through phone, fax, email or portal.
- Release held billing in the computer system to bill to the insurance companies.
- Request to reimbursement team when adjustments are required for non-covered services and/or denials.
- Verify eligibility and benefit information and update systems. Communicate with patient, pharmacy, enteral, and billing teams with any changes or if insurance is not contracted with the company.
- Follow up with all parties regarding authorizations, denials, and any other documentation required for patient’s new or continued care.
- Acknowledges and follows all HIPAA guidelines
- Communicates with physician’s office and insurance companies.
- Verify that patient is current and eligible with their insurance. Track and obtain completed DWOs from patients.
Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Required Education/Experience: Education or experience equivalent to a high school diploma is required.
Desired Education/Experience: Billing, coding, and/or insurance experience is desirable.
Computer Skills: To perform this job successfully, an individual will have knowledge of CPR+, basic Microsoft Outlook, Word and Excel skills. Ability to navigate through Internet Explorer, Google Chrome and Mozilla Firefox to obtain information necessary to care for our patients.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The employee must occasionally lift and/or move up to 10 pounds. While performing the duties of this job, the employee is frequently required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand and walk.