Summary: As a member of our Clinical Team, this position is responsible to communicate with insurance carriers via web, phone, and fax to obtain benefit and authorization requirements. Processing pre-service authorizations for injectable medications, physical and occupational therapies, radiology advanced imaging, and surgical procedures.

Essential Functions as a Preauthorization Specialist:

• Obtains authorizations for procedures, physical or occupational therapy, in office, as well as external injections, diagnostic testing, and surgeries as required by patient’s health care insurers or managed care providers.

• Drives requests, tracking and obtaining pre-authorization from insurers within time allocated for medical and therapy services being performed.

• Research referrals to deny or approve based on information obtained and appropriately identify diagnosis (CPT and ICD-10 coding).

• Operate online insurance verification websites.

• Communicate any insurance changes or trends among the team.

• Educate patients and coworkers on preauthorization process and assist with understanding coverage information.

• Utilizes Electronic Medical Record to document all patient and authorization communications.

• Maintains confidentiality of all patient information and comply with HIPAA regulations.

• Attend in-house continuing education seminars offered to staff.

• May assist with surgery scheduling and navigator as assigned.

• Other duties may be assigned.

Qualifications

• At least 2 years of work experience in medical office setting, orthopedics and/or surgery preferred.

• Proficient knowledge of medical terminology.

• Strong understanding of insurance plans and billing rules.

• Ability to demonstrate a mature, dependable, and responsible approach interacting with patients, providers, co-workers, and additional outside resources.

• Proficient in computer software, including Microsoft Office suite of products.

• Excellent time management, organization, and administrative support skills.

• Problem solving skills in standardized situations.

• Ability to work accurately and efficiently.

• Must be able to work closely with physicians and other team members.

• Team player.

• Bi-lingual/Spanish skills for interpreting a plus.