What are the responsibilities and job description for the Procedure Authorization Specialist position at The CORE Institute?
Monitors the authorizations of upcoming surgical cases on the physician’s calendars ensuring authorizations for surgeries are obtained in a timely and accurate manner.
• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms necessary information to allow processing of claims to insurance plans.
• Accurately completes surgical cost analysis form, documenting the required surgical cost estimation for collection prior to services.
• Verifies benefits on all surgical procedures.
• Document authorizations and progress of authorizations in the patient’s chart. Enters the authorization information within case management.
• Must be able to communicate effectively with physicians, patients, and co-workers and be capable of establishing good working relationships with both internal and external customers.
• Participate in providing ongoing training and education of staff as it relates to new processes to ensure timely confirmation of surgical cases.
• Work with department manager to respond to and reduce complaints timely and professionally.
• Assist surgery schedulers with STAT authorizations.
• Ensure strict confidentiality of all health records, member information and meet HIPAA guidelines.
• Assists in identifying opportunities for improvement within the daily workflow process.
• Attends department meetings as required.
EDUCATION
• High school diploma/GED or equivalent working knowledge preferred.
EXPERIENCE
• A minimum of 2 years of experience in the healthcare field is required and previous experience in referrals/authorizations,
front office, and/or charge posting is preferred.
• Excellent organizational skills and strong customer service orientation are required with a strong background in computers and data entry.
KNOWLEDGE
• Working knowledge of eligibility, verification of benefits, and prior authorizations from various HMOs, PPOs, commercial payers, and other funding sources.