Authorization-Referrals Specialist II #Full Time
About The Position
Top Healthcare Provider Network The 61st Street Service Corporation, provides administrative and clinical support staff for ColumbiaDoctors . This position will support ColumbiaDoctors, one of the largest multi-specialty practices in the Northeast. ColumbiaDoctors practices comprise an experienced group of more than 2,800 physicians, surgeons, dentists, and nurses, offering more than 240 specialties and subspecialties. Opportunity to grow as part of a Revenue Cycle Career Ladder! Job Summary: The Authorization-Referrals Specialist II is responsible for verifying insurance policy benefit information, and securing payer required referrals and authorizations. This position is responsible for obtaining accurate and timely pre-authorizations for professional services prior to the patients visit, scheduled admission, or immediately following hospital admission. Prior authorizations may include, but are not limited to surgical procedures, outpatient treatments, medications and diagnostic testing (i.e. ultrasounds, labs, radiology, IV therapy, referrals)
Requirements
- High school graduate or GED certificate is required.
- A minimum of 1-year experience in a physicians billing or third payer environment.
- Candidate must demonstrate the ability to understand and navigate managed care eligibility, insurance billing requirements, and obtaining pre-authorizations.
- Functional proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.)
- Functional proficiency and comprehension of medical terminology.
Nice To Haves
- Experience in Epic and or other of electronic billing systems is preferred.
- Knowledge of medical terminology, diagnosis and procedure coding is preferred.
- Previous experience in an academic healthcare setting is preferred.
Responsibilities
- Verify insurance coverage and update any changes in the billing system.
- Confirm providers participation status with patients insurance plan/network.
- Determine payer referral and authorization requirements for professional services.
- Contact patient and PCP to secure payer required referral for planned services.
- Initiate authorization and submits clinical documentation as requested.
- Follow through on pre-certifications until final approval is obtained.
- Manage faxes, emails, and phone calls.
- Communicate with surgical coordinators regarding authorizations status or denials.
- Submit appeals in the event of denial of prior authorizations or denial of payment.
- Calculate and document patient out of pocket estimates and provide to patient.
- Serve as primary liaison between faculty practice/department, insurance companies and patient to verify eligibility and coordination of benefits and resolve any insurance complications.
- Assists Supervisor with special projects and/or tasks.
- Assists Authorization-Referrals Specialist I with complex cases or questions.
- Serves as back-up to Authorization-Referrals Specialist III.
- Performs other job duties as assigned.
Benefits
- Healthcare
- Paid Time off
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
