Authorization Specialist

Schuylkill • Pottstown, PA

6h • Onsite

About The Position

The Authorization Specialist obtains benefits and authorizations for surgical procedures, diagnostic testing, medications, outgoing referrals, and other services. The role determines authorization protocols for health plans and performs billing duties to help ensure timely and proper payment from insurance carriers and patients. The position collaborates with physicians and provider office staff, communicates with insurance companies, and reviews schedules and work queues to verify that required authorizations are in place before patient visits.

Requirements

• High school diploma or GED with specialized training in insurance, coding, billing, or similar healthcare certificate programs.
• At least 1 year of experience in a healthcare setting performing insurance verification or authorizations.
• Familiarity with billing procedures and payer reimbursement.
• Knowledge of patient rights and laws relating to those rights, such as HIPAA.
• Proficiency in utilization management processes, standards, and managed care.
• Proficiency in standard medical practices and insurance benefit structures.

Nice To Haves

• Associate's degree.

Responsibilities

• Collaborate with physicians and provider office staff to determine appropriate authorizations based on medical necessity and the treatment plan.
• Check medical necessity by determining whether procedures and diagnoses support the required criteria.
• Obtain authorizations in accordance with network policy and communicate exceptions to the ordering office, patient, and manager.
• Communicate with insurance companies to obtain insurance verification, benefits, and precertification approvals.
• Verify additional clinical information and insurance authorizations or referrals.
• Review and monitor work queues and schedules to ensure accurate authorization is received before a patient's visit.
• Maintain compliance with benchmark data for accounts registered versus scheduled procedures.
• Estimate patient financial responsibility using insurance verification information, payer contracts, and/or self-pay guidelines.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED