Authorization Specialist

Westchester Medical Center • Valhalla, NY

8d

About The Position

The Authorization Specialist performs complex clerical procedures to verify insurance information and obtain authorization for hospital procedures, tests, and office diagnostic testing. The role follows established rules and procedures, specified time frames, and regulatory requirements. The employee processes clinical information efficiently and promptly to prevent treatment delays and third-party payer denials while maintaining the confidentiality of patient information.

Requirements

• 1–3 years of experience in the health care field.
• High school diploma or equivalency.
• Maintain confidentiality of patient information.

Nice To Haves

• Previous experience with the pre-authorization process.

Responsibilities

• Serve as a liaison between physicians, office staff, patients, and insurance carriers regarding the authorization process.
• Collect and review patient demographic and insurance information for accuracy.
• Collect and submit the documentation and diagnosis needed for authorizations.
• Advise physicians, surgical coordinators, and practice administration about insurance authorization problems, and resubmit requests with additional or revised information as needed.
• Notify providers when peer-to-peer reviews are needed for cases initially denied authorization, and assist with arranging those reviews.
• Follow up daily with insurance carrier authorization departments to check request status and support timely delivery of services.
• Follow policies intended to prevent denials or patient delays.
• Perform insurance eligibility checks on payer websites and through RTE.
• Use automated systems to perform work assignments.
• Review diagnostic testing schedules at multiple locations on an ongoing basis to capture changes, including add-on testing.
• Review daily which procedure authorizations have been processed and which remain outstanding.
• Log deliveries of medications received from specialty pharmacies daily and notify the appropriate person through the EMR and in person.
• Perform other tasks as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED