Job description

Job Title: Authorization Specialist

Department: Business Office

FLSA Classification: Non-Exempt/Hourly

Job Reports To: Business Office Supervisor

Job Summary

Responsible for obtaining PCP insurance referrals, authorizations and accurately document records.

Responsibilities/Activities

• Proficient knowledge and understanding of the referral/authorization process
• Ability to research and analyze data
• Ability to organize and prioritize work and manage multiple priorities
• Ensure all necessary referrals/authorizations are in place prior to patient being treated
• Review and process referral and authorization requests
• Communicate with providers and staff regarding referral/authorization status
• Prepare and send referral/authorization requests to insurance contractors and coordinate with referring providers and PCPs offices.
• Review referral/authorization requests for accuracy and completeness. Ensure correct CPT and ICD10 codes are utilized
• Scan and load incoming referrals/authorizations to EHR
• Maintain up-to-date data notes throughout the referral/authorization process
• Respond timely to insurance company inquiries

· Represent the practice in a professional manner and treat all customers, both internal and external, in a courteous manner

· Comply with all applicable laws and regulations including HIPPA and practice protocols

· Perform other duties of the medical practice that may be assigned

Skills

· Experience working as a referral coordinator and authorization specialist, ophthalmology experience a plus

· Ability to learn ModMed quickly and efficiently

· In-depth knowledge of insurance plan requirements

· Strong computer skills with a high degree of accuracy on data entry and attention to detail

· Strong verbal and written communication skills

· Convey both tact and diplomacy in patient, vendor, and co-worker relations, displaying excellent customer service skills

· Must be able to multi-task and work in a fast-paced environment.

· Must maintain patient confidentiality in accordance with clinic policy and HIPPA guidelines.

· Ability to work independently while demonstrating a good teamwork, ability to be positive, enthusiastic, and helpful

Minimum Requirements:

High school diploma or GED, two years previous experience in insurance authorizations

Essential Physical Functions:

Work may require sitting for long periods of time, stooping, and bending/stretching for supplies. Requires occasional lifting of files or paper weighing up to 25 pounds. Requires manual dexterity sufficient to operate a keyboard, calculator, telephone, and other office equipment. Hearing must be in normal range for telephone contacts.

Work Environment:

Work is performed in an office environment where the noise level can be moderate to loud and involves high level of contact with patients and the public via the telephone.

Reasonable accommodations may be made to enable individuals to perform the essential functions.

Equipment Used:

Multiline phone system, computer, copier/fax/printer

Additional Comments:

Please note this job description is an overview and not designed to cover all responsibilities and duties for this position. Duties, responsibilities, and activities may change at any time with or without notice based on the business needs of the clinic.

Equal Opportunity Employer M/F/D/V

Job Type: Full-time

Pay: $17.98 - $21.65 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Weekly day range:

• Monday to Friday

Work Location: In person