Authorization Specialist

Mangrove Management Partners•Boston, MA

23h

About The Position

The Authorization Specialist will be responsible for financially securing scheduled surgical procedures undertaken by the Vascular Care Group by verifying insurance eligibility and coverage of incoming patients.

Requirements

Bachelor’s degree preferred
1+ years of surgical insurance verification experience required
Vascular experience preferred
Working knowledge of eligibility, verification of benefits, and prior authorizations from various HMOs, PPOs, commercial payers and other funding sources
Proficiency in establishing good working relationships with both internal and external vendors/customers, both in person and over the phone
Outstanding written and verbal communication skills, with close attention to detail
Demonstrated ability to analyze data and work independently within a fast-paced work environment
Proficiency in technology, in particular Microsoft Office Suite
Excellent organizational and prioritization skills

Nice To Haves

Vascular experience preferred

Responsibilities

Monitoring upcoming surgical cases, procedures and imaging on the physician’s calendars
Responsible for identification and authorization of all codes that may be used throughout complex and variable patient treatments
Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms necessary information to allow processing of claims to insurance plans
Collaborates with other departments to ensure documentation is received prior to services
Assists with medical necessity documentation to expedite approvals and ensure the appropriate follow-up
Obtains, distributes, and documents referral authorization numbers
Helps monitor cancellations, expirations, and changes to authorizations and referrals
Documents authorizations and progress of authorizations in the patient’s chart
Ensures all updates to documentation in client's file are completed in a timely manner
Assists with the resolution of authorization related denials and billing holds
Participates in providing ongoing training and education of staff as it relates to new processes to ensure timely confirmation of surgical cases
Ensures compliance with appropriate industry regulations and State and Federal regulations
Safeguard strict confidentiality of all health records, member information and meet HIPAA guidelines
Assists with medical record requests, front desk tasks, and patient collections as needed
Performs other duties as assigned