Authorization Specialist

OSS Health•York Township, PA

22h

About The Position

The basic function of the Authorization Specialist is to verify benefits/eligibility and obtain authorizations when necessary for visits, procedures, surgery, treatment, and testing with the patient’s corresponding insurance company as authorized by the physician. The Authorization Specialist will serve as a liaison between the clinical team, provider, outside facilities and the patient.

Requirements

One-year relevant experience in the medical field or in prior authorization required.
Must have basic knowledge and understanding of CPT/ICD10 codes for insurance verification. Must have basic knowledge and understanding of medications, advanced imaging studies and surgical procedures.
Must have strong clinical knowledge and understanding of medical terminology and anatomy. Orthopedic knowledge is preferred.
Must have proficient computer skills, including Microsoft Office, and skills utilizing basic office equipment.
Must be detail oriented, have excellent organizational and prioritizing skills and be able to meet competing deadlines.
Must possess a high level of analytical skills and critical thinking.
Must be able to work independently. Must be able to demonstrate initiative to provide quality and improve efficiency with an assigned workload.
Must have excellent communication skills, both written and verbal, to ensure communication is accurate.
Must have good telephone etiquette, and be able to answer the phones, identify self and direct calls appropriately.
Must be able to demonstrate flexibility by adapting to new and changing duties to meet patient needs effectively and with efficiency.
High School Diploma or equivalent required; Licensed Practical Nurse (LPN) or certified Medical Assistant (MA) highly preferred.

Responsibilities

Screens and analyzes the patient’s medical records for the documentation and criteria required to meet medical necessity for the authorization process.
Obtains patients benefit information from the insurance company.
Familiarizes self with medical policies and criteria for each insurance company.
Follows up in a timely manner with the doctor’s team if additional information is needed.
Reviews clinical documents with Nurse Reviewers and/or Utilization Managers at various insurance companies and third-party administrators.
Coordinates with other OSS department staff, external facility staff and external companies to ensure authorization/referral is obtained.
Communicates with external locations to ensure shipment of injection to OSS.
Ensures authorization is secured with the insurance company prior to scheduled service.
Obtains authorization timely when the service requires an auth prior to scheduling.
Contributes to the development and delivery of team training initiatives.
Communicates with physician’s team to notify patients when unsuccessful at obtaining pre-certification/authorization.
Documents the results of the process in the EMR systems for future reference and for claims processing.
Addresses concerns of insurance companies as well as patients in a professional, calm and understanding fashion.
Maintains an orderly and neat work area.
Maintains confidentiality and always protects sensitive data, including and not limited to patient information.
Maintains performance in alignment with audit standards set by the team/department.
Creates and modifies vendor reports.
Other duties as assigned