Authorization Specialist

The Prelude Network•Houston, TX

47d

About The Position

Our Authorization Specialist will be responsible for providing a great patient experience by checking patient eligibility and initiating prior authorizations. This includes utilizing online resources, reviewing medical records, calling insurance companies, and completing authorization forms in our Electronic Medical Record system. What this role entails: Check patient eligibility and insurance plan benefits via online payer portals and confirming with insurance companies Scan complete authorization form in EMR system Review medical records Initiate authorizations using online resources, insurance specific forms, and making outgoing calls to insurance companies Follow department procedures to ensure timely completion of benefit investigations Communicate with internal patient financial services department, clinical staff and external practice managers when inaccurate demographic information is supplied Review and update authorization information in the EMR system Support and actively participate in initiatives designed to improve individual and organizational performance. Coordinate with clinical staff to set up peer to peer meetings for physicians and insurance medical directors. Assist patients with insurance denials and appeals Performs other duties/special projects and tasks as assigned

Requirements

Able to read, interpret, and implement specified records.
Knowlege of Medical and Diagnosis codes (CPT/DX)
Demonstrated knowledge of medical terminology and office procedures.
Demonstrated knowledge of third-party and insurance company operating procedures, regulations and billing requirements.
Experience with Microsoft Office suite and Electronic Medical Record (EMR) system.
Ability to effectively establish and maintain cooperative and effective working relationships
Effectively prioritize competing responsibilities, with a sensitivity toward matters which are time sensitive.
Exercise a high level of discretion and sensitivity to patient privacy.
Ability to recognize, evaluate, solve problems and correct errors.
Ability to use telephone, keyboard, computer, office equipment and software programs.
High School diploma or equivalent required
1-3 years' work experience in a healthcare environment required

Responsibilities

Check patient eligibility and insurance plan benefits via online payer portals and confirming with insurance companies
Scan complete authorization form in EMR system
Review medical records
Initiate authorizations using online resources, insurance specific forms, and making outgoing calls to insurance companies
Follow department procedures to ensure timely completion of benefit investigations
Communicate with internal patient financial services department, clinical staff and external practice managers when inaccurate demographic information is supplied
Review and update authorization information in the EMR system
Support and actively participate in initiatives designed to improve individual and organizational performance.
Coordinate with clinical staff to set up peer to peer meetings for physicians and insurance medical directors.
Assist patients with insurance denials and appeals
Performs other duties/special projects and tasks as assigned

Benefits

Comprehensive Health Coverage: Medical, dental, and vision plans for our full-time employees, along with complimentary basic life insurance, Employee Assistance Program, and long-term disability insurance. FREE or low-cost employee-only healthcare coverage option is also available.
Family Building Support: Take advantage of our comprehensive fertility benefits, adoption assistance, and surrogacy support to help grow your family.
Paid Parental Leave: Generous maternity, paternity, and partner leave so you can focus on what matters most.
Plenty of Paid Time Off: Start with 18 days of PTO annually and enjoy 11 paid holidays, including one floating holiday to use as you choose!
Retirement Ready: Invest in your future with our 401(k) plan, featuring a competitive company match and full vesting after just 2 years.
Lifestyle Spending Account: Access a company-funded account to reimburse expenses that boost your physical, financial, and emotional well-being.
Health Savings Account (HSA): If eligible, enjoy regular employer contributions to your HSA with every paycheck.
Rewards for Connections: Earn extra money with our Employee Referral Program-your network is invaluable!
Growth Opportunities: We support your career with continuing education reimbursement and dedicated time off for professional development.
Premium Calm Health Subscription: Enjoy a free premium Calm Health app subscription to support your mental wellness.
Emotional & Work-Life Support: Through our Employee Assistance Program (EAP) with SupportLinc, you'll have access to emotional well-being and work-life resources whenever you need them.
Extra Peace of Mind: Explore additional coverage options including Accident, Critical Illness, Hospital Indemnity, and Pet Insurance, to suit your needs.