Medical Authorization Specialist

Department: Business Office

Immediate Supervisor Title: Authorizations Department Lead

Responsibilities:
• Handles the verification of insurance benefits for patients
• Notifies patient of deductibles and co-insurance due as needed
• Contacts primary care physicians in regard to referrals
• Request referrals for services, including appointments and procedures
• Regularly calls insurance companies to follow up
• Explores other payment options with customer when needed
• Keeps sensitive patient and company information confidential
• Contacts patient when needing to obtain information
• Request, track and obtain pre-authorization from insurance carriers within time allotted
for medical and services.
• Review patient's medical history and insurance coverage for approval
• Contact referring physicians for additional information as needed
• Input new patient information and update information in our system
• Monitor schedule for potential issues
• Complete billing documentation
• Assist with other clerical tasks as needed
• Secure prior authorizations prior to services being performed.
• Demonstrate and apply knowledge of medical terminology, high proficiency of general
medical office procedures including HIPAA regulations.
• Communicate any insurance changes or trends among team.
• Maintains a level of productivity suitable for the department.
• Clearly document all communications and contacts with providers and personnel in
standardized documentation requirements, including proper format.
• Regular attendance required
• Performs other related duties as assigned or requested.
• The company reserves the right to add or change duties at any time.

Qualifications:
Education: High School diploma or GED required

Experience: Minimum 2 years of workers compensation

Experience: Minimum of 1 year experience as a medical biller/coder
Experience with electronic scheduling system and electronic medical records (EMR) required.
Familiar with medical terminology

Performance Requirements:
Knowledge:
1. Knowledge of principles and processes for providing customer and personal services.
This includes customer needs assessment, meeting quality standards for services, and evaluation
of customer satisfaction.
2. Knowledge of administrative and clerical procedures and systems such as word
processing, managing files and records, stenography and transcription, designing forms, and
other office procedures and terminology.

Skills:
1. Skill in identifying patient concerns and correcting or notifying supervisor.
2. Actively listening and speaking to patients and understand and ask questions to ensure
patient experience is at the highest level.
Abilities:
1. Ability to read and write instructions, and comprehend simple instructions, short
correspondence, and memos.
2. Ability to competently use Microsoft Office.