Authorization Specialist

Ramey-Estep / Re-group•Ashland, KY

1d•$16 - $20•Onsite

About The Position

The Authorization Specialist is primarily responsible for securing prior authorizations for medical and behavioral health services by reviewing patient medical history, verifying insurance coverage, and confirming referral details with current and referring providers. This role ensures timely submission and follow-up on authorization requests, monitors the schedule for add-on patients to prevent conflicts, and confirms that all necessary approvals are in place prior to appointments or procedures.

Requirements

Must be at least 21 years of age.
Must have strong leadership and organizational skills.
Must have excellent communication and conflict-resolution skills.
Technical requirements include proficiency with Microsoft Word, Excel, PowerPoint, and any other applications used by the organization or regulatory agencies.
Ability to understand and relate to the needs of clients from diverse backgrounds.
Ability to read, write, and converse in English.
Successful completion of a pre-employment drug screen.
Successful completion of a background screening.
Successful completion of a TB skin test or proof of a negative chest x-ray or other documentation.
Maintains 20 hours of Annual Training through Relias or other appropriate sources.
Attends all assigned training specific to job assignment.

Nice To Haves

An Associate’s Degree is preferred.
Prior experience in medical billing or insurance authorization is strongly preferred.
Knowledge of medical terminology is preferred.

Responsibilities

Completes and submits prior authorizations, referrals, and precertification forms for services, appointments, and procedures per payer requirements.
Reviews patients’ medical history and insurance coverage to determine authorization needs and obtain required approvals.
Collects and uploads relevant medical documentation from the electronic health record (EHR) system to support authorization requests.
Coordinates with providers, office staff, and referring physicians to gather additional clinical information, especially in denied authorizations.
Schedules and facilitates peer-to-peer reviews between providers and payers when required.
Monitors and follows up on submitted authorizations, documenting all communications and status updates.
Enter authorization approvals and related information into the EHR to support accurate and timely billing.
Notifies providers of approval determinations and ensures all necessary authorizations are in place before patient appointments or procedures.
Conducts eligibility verifications for incoming and existing patients.
Maintains and updates spreadsheets to track reauthorization or renewal dates, helping to prevent lapses in required approvals.
Regularly reviews payer websites for updates to CPT codes and authorization policies and communicates relevant changes to the appropriate staff.
Input new patient information and update existing records as needed.
Monitors the patient schedule to identify potential issues related to authorization or eligibility and resolve conflicts proactively.
Completes billing documentation accurately and promptly.
Monitors incoming faxes, emails, and phone calls to ensure prompt receipt of authorization decisions and timely communication with payers.
Assists with general clerical and administrative tasks to support the department.
Participates in supervision and consultation regularly.
Ability to be flexible and adapt to changes in schedules and work environment.
Ensure all necessary records are maintained and kept confidential.
Ensure entries in all treatment plans and narrative reports to MCOs are done professionally and concisely and will be submitted as needed to maintain a current authorization for services.
Collaborate effectively with other RE services and community partners.
Promotes a positive view of RE to the public and outside agencies.
Performs other duties as assigned.