Authorization Specialist SSC

This employee verifies insurance, obtaining authorizations and documents needed to confirm order; responsible for communicating directly with the patient, doctors' offices, insurance companies, and centers associated with the patient's account.

Job Responsibilities:

• Prioritize incoming prior authorization requests
• Evaluate and triage prior authorization rejections to determine validity of the prior authorization
• Communicate as needed with patients regarding clinical information to be used when submitting the prior authorization
• Review patient chart documentation to ensure accuracy of prior authorization submissions
• Request, track, and obtain prior authorization from insurance carriers within time allotted for medical and services using my meds, fax, or verbal communication
• In a timely manner, follow up on prior authorizations that have been submitted with no response from the insurance carrier
• When justifiable, initiate appeals for denied authorizations
• Maintain patient files on Prior Authorizations tracker
• Compose letters for various situations to include medical necessity letters and appeal letters
• Use ICD-10 diagnosis codes accurately and properly in the submission of prior authorizations
• Contact patients via the platform to update the status of their prior authorization
• Assist patients with medication assistance programs to include obtaining signatures from providers, submit documentation to medical assistance programs, and tracking progress
• Demonstrate and apply knowledge of medical terminology
  • high proficiency of general medical office procedures including HIPAA regulations
• Communicate with pharmacies/insurance carriers via phone, fax, or written communication
• Maintain 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

• Evaluate options and make efficient decisions
• Maintain consistently accurate records
• Proficiency with multiple programs that include the use of internet and email
• Learn how to use new software
  • AS400
  • LITE

Education and Experience:

• High School Diploma or equivalent (GED) required

Physical Demands:

The employee may frequently lift and/or move up to 10 pounds and may occasionally lift and/or move up to 25 pounds.