Our practice is currently seeking a full-time Authorization Specialist / Receptionist to join our team!

Job Title : Authorization Specialist / Receptionist

Department : Clinical

Immediate Supervisor Title : Clinical Nurse Manager

General Summary : A full-time position responsible for obtaining the authorizations based on medical necessity and treatment plan provided.

This position is also responsible for receiving incoming telephone calls in a prompt, courteous, and professional manner, greeting and assisting visitors and performing check-in tasks for patients.

Essential Job Responsibilities :

Authorization

• Checks eligibility and benefits of medical insurance, documenting information into the software system and communication of patient liability to patient and providers.
• Reviews scheduled appointments to determine the need for referrals and follow up as indicated.
• Obtain pre-authorization for scheduled diagnostic imaging and procedures
• Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services before services are rendered.
• Responsible for verification and investigation of pre-certification, and referral requirements for services.
• Coordinates and supplies information to the payer including medical information and / or letter of medical necessity for determination of benefits.
• Collaborates with designated clinical contacts regarding encounters that require peer-to-peer review.
• Appropriately prioritizes workload to ensure the most urgent cases and diagnostic imaging are handled in a timely manner.
• Answers provider, staff and patient questions surrounding insurance authorization requirements.
• Promptly and professionally answers telephone calls. Routes calls appropriately as needed.

Front office

• Greets visitors and assists them as appropriate. Phones or pages employees to meet visitors, directs visitors to appropriate waiting areas, and appropriately and courteously screen solicitors for relevance to organization needs.
• Performs patient check-in for appointments. Explains financial requirements to the patients or responsible parties and collects copays and balance due monies as required.

Verifies patient information and insurance participation for practice.

• Copies / scans insurance cards, verify information for accuracy.
• Schedules appointments for patients by telephone or at the check- in desk based on provider's schedules and availability.
• Daily management of outpatient queue and patient no show letters.
• Electronic order entry using EPIC Care link for radiology orders.

Education : High school / GED.

Experience :

One year of experience in medical practice setting with precertification experience preferred.

Required skills / abilities :

• Excellent interpersonal and customer service skills.
• Basic understanding of administrative and clerical procedures and systems.
• Proficient with Microsoft Office Suite or related software
• Familiarity with medical terminology and medical supplies.

Equipment Operated :

Standard office equipment with emphasis on computer hardware and software as well as telephone use.

Work Environment :

In - office setting, well-lighted, good air quality. The noise level in the work environment is usually moderate.

Mental and Physical Requirements :

Light to medium duty. Ability to stand, walk, sit for long periods of time, bend, reach, push and lift up to fifty (50) pounds.

Last updated : 2024-05-10