Authorization Specialist

Senior PsychCare•Houston, TX

75d

About The Position

Senior PsychCare is hiring for an Authorization Specialist. The position is primarily responsible for obtaining required pre-authorizations and helping to process referrals for all services accurately and timely.

Requirements

Knowledge with in and out of network insurances, insurance verification, and process for prior authorization
Familiarity with ICD-10 and CPT codes and procedures
Ability to review and understand patient medical documentation
Ability to independently identify and understand medical necessity requirements
Task-oriented and organizational skills; ability to complete tasks timely
Detail-oriented focus; being careful about detail and thorough in completing work tasks
Ability to work independently and as a team
Ability to adapt with flexibility
Effective communication skills (written/verbal)
High school diploma or GED
Three (3) years authorizations experience with Medicare/Medicaid MCO’s (Behavioral Health experience Preferred)
Strong working knowledge of insurance coverages and billing processes.
Experience with basic desktop software including Microsoft Office

Responsibilities

Prioritize incoming authorization requests according to urgency
Initiate, verify, and complete procedure authorization/referral process
Resolves day-to-day issues pertaining to pre-authorization, as needed
Monitor provider network status
Obtain authorization by fax, payer website or by phone and follow up regularly on pending cases.
Notify appropriate departments for approvals and denials
Initiate and assist with appeals for denied authorizations
Effectively maintain, monitor, and update payer medical policy guidelines to manage authorization requirements
Request, review, and submit necessary patient documentation as needed to ensure approval of authorization
Collaborate with healthcare providers and insurance companies to resolve any issues related to prior authorization
Stay current with changing insurance policies and regulations
Effectively utilizes ICD 10, CPT, modifiers and/or other codes according to coding guidelines when requesting Authorizations
Communicates effectively with provider and/or all appropriate parties regarding missing information such as CPT, diagnoses codes, documents, clinical reports, etc. to ensure proper authorization processing
Communicates effectively with other departments regarding changes and/or updates with patient accounts and status
Manages the status of accounts and identify inconsistencies
Responds to billing inquiries
Uses downtime efficiently; is aware of team members workload
Makes recommendations on workflow improvement as needed