Job Description
Job Description
AUTHORIZATION SPECIALIST
Our highly professional Authorization Specialist is responsible for pre-certification and pre-authorization for procedures, treatment(s), and testing. The Authorization Specialist has a high proficiency for communicating internally as well as with patients and their families regarding the needs/status of prior authorization. This position reports to the Practice Administrator.
PRIMARY RESPONSIBILITIES
- Works directly with the insurance companies, Chicago ENT staff/providers, and external referring staff/providers to ensure an efficient authorization process.
- Daily monitors schedules and orders to begin prior authorization.
- Accurately verifies patient insurance/benefits before beginning prior authorization.
- Communicates plan limitations or non-covered services with ordering physician and patient.
- Monitors prior authorization from initiation to completion:
- Submits all ordered CPT and ICD-10 diagnosis codes.
- Submit necessary clinical information, coordinate peer-to-peer calls, and appeals denied authorizations.
- Once approved, alerts the patients and providers, and documents status on EMR appointment.
- Records prior authorization/reference numbers in the EMR for billing department.
- Answer, screen, respond, and rout phone queries in addition to checking voicemails, telephone encounters, faxes, and other inbound communication.
- Cooperate and maintain good rapport with admin staff, medical staff, other departments, and visitors.
- Review denied claims and proactively work with billing to identify processing issues and errors.
- Act as an expert to answer questions from patients and staff.
- Maintain a professional approach with confidentiality regarding all patient information.
- Performs other selected administrative duties as directed by physicians or Practice Administrator.
REQUIRED QUALIFICATIONS
- Two years of medical insurance verification and authorization experience.
- Excellent organizational skills and attention to detail.
- Excellent verbal and written communication, and interpersonal skills.
- Excellent time management skills.
- Strong analytical and problem-solving skills.
- Must have the ability to remain calm in stressful situations, to be flexible, to work well with many interruptions and to be able to multi-task.
- Must exhibit and promote a high level of customer service, hospitality, curiosity and friendliness towards all patients, employees, and the overall facility.
- Bilingual preferred.
- Proficiency in completing pre-authorizations via insurance web sites.
SUPERVISORY RESPONSIBILITY
This position has no supervisory responsibility.
CERTIFICATES, LICENSES, REGISTRATIONS
None required.
ENT is a drug-free environment and an Equal Opportunity Employer. We offer competitive salaries and benefits, including medical/dental, life and disability coverage, generous vision benefits, a 401 (k) plan with a match, vacation time, and weekends and major holidays off.
All applicants should be aware that employment is contingent upon the successful completion of a background check and drug screening. Failure to provide accurate information or pass these requirements may result in withdrawal of the employment offer.