Authorization Specialists

Healthcare Outcomes Performance Co. (HOPCo)•Cypress Lake, FL

5d•Onsite

About The Position

The Authorization Specialist is responsible for monitoring upcoming cases on physician’s calendars, ensuring timely and accurate authorization for office visits. This role involves documenting authorizations and their progress in patient charts and within the case management system. The specialist must communicate effectively with physicians, patients, and co-workers, and establish strong working relationships with internal and external customers. They will also work with the department manager to address and reduce complaints professionally and ensure strict confidentiality of all health records and member information, adhering to HIPPA guidelines.

Requirements

Effective in organization and billing requirements and authorization process
Medical terminology.
Skill in using computer programs and applications including Microsoft/ Excel, Microsoft Word and Outlook.
Knowledge of insurance plans and procedures.
Adherence to all policies and procedures, including standards for safety, attendance, punctuality, and personal appearance.
Must be able to establish and maintain effective working relationships with management and peers.
Ability to multitask in a fast-paced environment.
Must be detailed oriented with strong organizational skills.
Ability to work independently and demonstrate the ability to analyze data

Responsibilities

Monitor the authorizations of upcoming cases on physician’s calendars ensuring authorization for office visits is obtained in a timely and accurate manner.
Document authorizations and progress of authorizations in the patient's chart. Enter information within case management.
Communicate effectively with physicians, patients, and co-workers and establish working relationships with both internal and external customers.
Work with the department manager to respond to and reduce complaints timely and professionally.
Ensure strict confidentiality of all health records, member information and meet HIPPA guidelines.
Contact the insurance company to see if authorization is needed for injections, images, in-office procedures, and visits.
Obtain and document the authorization and benefit details and attach the information to claim for said dates of service.
Work with Medical Assistants and advise them of the status of authorization.
Maintain copies of the requests and the results by reference number and proof documents.
Perform related work as required and other projects and duties as assigned.
Assist in the insurance verification process as well as requesting referral authorization.
Contact patients to obtain accurate insurance information.
Participate in educational activities and attend monthly staff meetings.
Maintain real-time authorization chats via Athena and Outlook.
Responsible for medication sign out, order requests, and claim review.
Orders, receives, and maintain inventory of drugs and ensures their security within the facility.
Restock, label, collect, dispense and maintain inventory/ submission requests for medications.
Keeping track of follow ups and schedule patients accordingly.
Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue.