Authorization-Referrals Specialist III #Full Time

61st Street Service Corp•Fort Lee, NJ

About The Position

The Authorization-Referrals Specialist III is responsible for verifying insurance policy benefit information, securing payer required referrals and authorization prior to the patient’s visit, scheduled admission, or immediately following hospital admission. This position is responsible for obtaining accurate and timely pre-authorizations for professional services. The Authorization-Referrals Specialist III is also responsible for assisting management with the daily work assignment, staff training, and quality audits.

Requirements

High school graduate or GED certificate is required.
A minimum of 2 years’ experience in a physician’s billing or third payer environment.
Candidate must demonstrate the ability to understand and navigate managed care eligibility, insurance billing requirements, and obtaining pre-authorizations.

Nice To Haves

Certified Professional Coder certificate (CPC) is preferred.
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

Verifies insurance coverage via system tools, payer portals.
Confirms provider’s participation status with patient’s insurance plan/network.
Determines payer referral and authorization requirements for professional services.
Contacts patient and PCP to secure payer required referral for planned services.
Documents referral in practice management system.
Initiates authorization and submits clinical documentation as requested by insurance companies.
Manage faxes, emails, and phone calls in a timely manner.
Communicates with surgical coordinators regarding authorizations status or denials.
Submits appeals in the event of denial of prior authorizations or denial of payment following procedures.
Calculate and document patient out of pocket estimates and provide to patient.
Assists Supervisor with special projects and/or tasks.
Assists Authorization-Referrals Specialist I and II with complex cases pertaining to clearance of payer referrals, authorization or insurance eligibility issues.
Assist supervisor/manager with distribution of daily work assignments.
Assist with new-hire training and staff refresher training materials.
Monitor and replenish the unit’s office supply needs.
Performs other job duties as assigned.