Authorization Specialist-Resp. Therapy

JOB SUMMARY:  Performs all pre-authorization and authorization tasks required for treatment of patients in the Respiratory Therapy departments at Rivers Health. Enters all authorization data into EMR, sends all needed documentation to insurance companies as indicated.  Provides front desk coverage for Respiratory Therapy as well.    

1. Contacts insurance companies for prior authorizations and benefit coverage for all Respiratory, Pulmonary, Cardiac, Sleep, and EKG services].
2. Knowledge of Respiratory Therapy specific CPT and ICD-10 codes.
3. Completes subsequent re-authorizations as needed.
4. Verifies and documents insurance coverage for all services and procedures for prior authorizations and subsequent authorizations as needed.
5. Schedule and receive patients for all services related to and within the Respiratory Therapy Department.
6. Register all patients, contact insurances for prior authorization, and re-authorization.
7. Prepare and maintain patient charts, specifically authorization documentation.
8. Assist with ordering office supplies and equipment for department as indicated.
9. Complete all required forms for authorization and registration processes.
10. Answer the phone in an appropriate and courteous manner.
11. Maintain tidiness of office and waiting area. Clean desk/countertops, cabinets, etc. as needed.
12. Responsible for operation of copier, fax machine, computer, and other office equipment.
13. Demonstrates excellence in customer service skills.
14. Fosters an atmosphere of teamwork and collaboration.
15. Participates in staff meetings, in-services, and projects.
16. Contact physician office for written order and other documentation as warranted.
17. Assist in other department areas as needed on occasional basis as assigned by Manager or Director.
18. Perform other related duties as assigned by Manager or Director.

1. EDUCATION AND FORMAL TRAINING:
   1. High school diploma, or equivalent of high school diploma.

1. WORK EXPERIENCE:
   1. One to two years prior authorization and authorization experience preferred.

• KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:
  1. Must possess knowledge and understanding of pre-authorization and authorization processes in general. Should have good typing and mathematical skills.  Knowledge of billing practices, computers, and rehabilitation services.  Familiar with English composition, rules of spelling, grammar, punctuation, and ability to compose correspondence and edit work.  Must demonstrate good interpersonal skills and good communication skills.  Must be able to cope with stressful situations and prioritize multiple tasks.