Authorizations Specialist

Position Summary: The Authorization position is responsible for communication between the primary care and our office, surrounding all referral and authorizations.  This position is extremely important in facilitating and obtaining all authorizations needed to ensure patients are seen in a timely manner. All authorization staff are expected to communicate with patients and outside primary care physicians to secure all needed information, authorizations, and referrals to decrease patient delays.  Obtaining any insurance verification and authorizations for all in house testing prior to the visit date.  Ensuring accuracy with requesting referrals and entering in patient’s charts.

Reports to:  CBO Director

Flexibility:  While this job description is meant to provide an overview and specific responsibilities of the Authorization Specialist, ENTA Management reserves the right to make changes, adjustments and revisions, as needed, to this document and will coordinate such modifications with ENTA’s Practice Administrator and Physicians. While the normal work week is 40 hours, you may be subject to overtime (not to exceed 50 hours per week). 

Summary of General Duties:

• Chart prep assigned offices and send referral/authorization requests one week prior to appointments.
• Ensures that referrals are received for all upcoming appointments.  Enter referral into account and scan referral document.  Link referral to appointment.
• Ensure all authorizations accuracy for procedures codes, diagnosis, and validity dates.
• Maintain all add on emails sent to the authorization department in a timely manner.
• Maintains accuracy of insurance, patient billing, and contact information, by entering patient demographic and insurance information correctly into computer system.
• Schedule patient appointments within operational standards and documents appropriately. 
• Obtains benefits and authorizations for all in house testing.  
• Obtain referrals for outstanding services that were not able to be obtained prior to visit due to insurance requirements.
• To inform the patients if there is a wait time obtaining referral/authorization and reschedule appointments.  In such cases, the employee must be courteous, apologize for the inconvenience caused, and assure the patient that we are working to resolve any issues.
• Communicate with outside physician offices with professionalism and tact. Report any issues with outside offices to the CBO Director.
• Scan documents.
• Import faxes.
• Follow the release of information protocol established by ENTA that follows the HIPAA guidelines to release medical records.  
• Complete all tasks within the timelines established by the practice.
• Answer the telephone in a warm, friendly manner. 
• Directs urgent calls to the triage assistant and ensures that action is taken. 

Working Environment:

• Physical demands:  
  • Average percent of time during regular shift devote to:
    • Walking, Squatting, Sitting, Bending, Reaching:       75%
    • Standing:                                                                     25%
  • Average lifting requirements:
    • Lifting Requirements:           20-40 lbs.
    • Frequency of Lifting:              0-25% of the time
  • Additional physical demands:
    • Ability to grasp with both hands; pinch with thumb or forefinger; turn with hand/arm; reach for (above shoulder height).
    • Ability to type 60 wpm.
    • Ability to operate multi-line telephone system, computer keyboard and ten-key adding machine.

• Visual, Hearing, and Mental demands:  Vision adequate to perform essential functions such as read telephone displays/computer terminals for long periods of time, correctable to 20/20. Hearing is adequate to perform essential functions such as answering the telephone. Mental capacity adequate to perform essential functions such as quickly and accurately entering patient demographics and scanning documents while checking in multiple patients.  Tact to deal with unfriendly individuals regarding various situations, and adequately handle stress.
• Working Conditions: This position has an option to work from home after training has been completed. Performance, reliability, and overall fit for the role will be assessed prior to an employee being given permission to work remotely and will continue to be assessed once the employee has gone remote.  Required to exhibit a positive attitude and a professional appearance and show detail and accuracy. Required to exhibit quality performance of the essential job functions to help the practice run effectively and efficiently.

Position Requirements:

• High School education or GED equivalent.  
• Minimum two years of medical office experience preferred.
• Working knowledge of contracted insurance plans.
• Good verbal and written communication skills.
• Good telephone skills.
• Demonstrated ability to use a computer with Microsoft Word, Outlook and EMR software.
• Excellent customer service skills.
• Strong organizational skills with the ability to multi-task.
• The ability to attend work on a regular basis.
• The ability to adhere to safety rules and other reasonable regulations pertaining to the job.
• The ability to refrain from negativity or excessive irritability.
• The ability to work in cooperation with other workers.
• Ability to maintain confidentiality and thorough knowledge of HIPAA policies and procedures.