Authorization Specialist

The Children's Institute of Pittsburgh•Pittsburgh, PA

3d•Onsite

About The Position

At The Children’s Institute of Pittsburgh, we’ve built our legacy on being amazing. After more than a century of the highest quality care and service to children and their families, we’re forever proud of our team members who don’t just make a career here – they make a difference. The Authorization Specialist is responsible for interacting with payers and physician offices to obtain referral/authorization for outpatient services delivered at all sites. The Authorization Specialist is responsible for investigating the insurance coverage for all clients to ensure payment. The specialist will act as the point person for communication related to insurance benefit coverage.

Requirements

High school diploma or equivalent is required
Three years relevant insurance experience
Must be knowledgeable of insurance protocols and providers across all service lines
Strong, effective, and clear verbal, written and interpersonal communication skills
Has knowledge of commonly used concepts, practices, and procedures within health care field
Act 73 FBI, Act 34 Criminal Clearance, and Act 33 Child Abuse Clearance

Nice To Haves

Health care experience preferred

Responsibilities

Obtain certified and re-certified care plans as required
Monitor and ensures certified care plans are returned for all patients active in care
Knowledgeable of payor requirements
Obtain hardcopy of all authorizations
Accurately input appropriate documentation in EHR
Process changes in information pertaining to demographic and insurance information
Follow-up on authorization denials
Maintain consistent communication with front desk, billing department, providers, and families regarding authorization benefits and service options
Track the movement and expiration of authorizations
Manage all aspects of medical records, which includes fulfilling medical record requests and bill record requestor
Provide authorization reports upon request