The Authorizations specialist is responsible for ensuring all patients receive proper authorization before their procedures. The goal is to have these complete and approved timely to ensure that the procedure is not delayed. When a prior Authorization is not approved or pending approval, the authorization specialist will work with the necessary individuals to have documentation signed so the procedure can still be done timely and that the patient understands their financial obligations.

Essential Functions include but are not limited to:

• Ability to obtain benefits and authorizations for surgery patients and other procedures as required.
• Request peer to peer review by midlevel’s for any denied surgery or procedure authorizations
• Obtain retro authorizations or add CPT codes to original surgery authorization for the billing department
• Ability to schedule all outside testing once authorization is obtained. i.e. CT scans, Bone scans, stat ultrasounds, dexascans, cortisone injections, infusions, and wound care.
• Ability to write letters of medical necessity for DMEs, other patient visits, etc.
• Request out of network authorizations/gap exceptions, as needed, for patients having insurance which is out of network access.
• Good interpersonal skills in establishing effective working relations with staff.
• Ability to effectively train new staff members.
• Handling & protecting patient information.
• Promotes internal and external customer satisfaction.
• Builds and promotes a culture of service excellence and continuous improvement.
• Attendance: works as scheduled and is compliant with Attendance and Tardiness Policy.
• Perform all other duties as assigned.

Education & Qualifications:

• Required: High School graduate or equivalent
• Preferred: Associates degree; billing or authorization experience