Authorization Specialist - Patient Registration - Full Time
Titus Regional Medical Center•Mount Pleasant, TX
•Onsite
About The Position
The Authorization Specialist is responsible for obtaining appropriate insurance verification, and all authorization requirements during admission. The expertise of the Authorization Specialist shall include working knowledge in the area of authorization related activities including pre-authorizations, notifications, edits, denials, etc. The Authorization Specialist shall demonstrate the philosophy and core values of TRMC in the performance of duties.
Requirements
- One year of previous hospital or medical office experience in billing, pre-certification and authorization preferred.
Nice To Haves
- Associates degree in related field preferred.
- Completion of a medical terminology course or equivalent preferred.
Responsibilities
- Reviews demographic, billing, and insurance information for accuracy.
- Verifies insurance eligibility and makes necessary corrections.
- Obtains pre-certification and authorization.
- Responds to phone calls and correspondence relating to patient accounts.
- Displays positive and professional communication skills internally and externally.
- Works under pressure and resolves problems.
- Navigates insurance carrier websites.
- Reviews and interprets medical record documentation for patient history, diagnosis, and previous treatment plans to pre-authorize insurance plans determined procedures to avoid financial penalties to patients, providers, and the facility.
- Utilizes payer-specific approved criteria or regulations to determine medical necessity or the clinical appropriateness for inpatient admissions, outpatient facilities, office services, and drugs in terms of type, frequency, extent, site and duration, and considered effective for the patient's illness, injury, or disease
- Provides referral/pre-notification/authorization services timely to avoid unnecessary delays in treatment and reduce excessive non-clinical administrative time required of providers.
- Submits pertinent demographic and supporting clinical data to payer to request approval for services being rendered.
- Performs all other duties as assigned.
- Must maintain composure under stress.
- Follows and adheres to TRMC vaccine policy(s) mandated by the Centers for Medicare & Medicaid Services (CMS).
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
