Authorization Specialist
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About The Position
The position involves verifying patient insurance coverage in a timely manner using phone or online resources. The role requires submitting prior authorizations to insurances through payer-specific portals and vendors, ensuring that all necessary medical documentation is accurate and present before submission. Regular follow-ups on pending authorizations are essential to obtain current statuses and to identify any actions needed for approval. The position also entails communicating any authorization denials to the appropriate staff and handling discrepancies, errors, or omissions related to denials, including filing appeals when necessary. Participation in educational activities and regular staff and department meetings is expected, along with maintaining excellent turnaround times for timely authorizations. The role requires a positive and cooperative attitude while working with team members and management, demonstrating flexibility to perform duties as needed. Collaboration with other departments to assist in obtaining pre-authorizations is also a key responsibility, along with documenting activities appropriately in process notes and participating in the Quality Assurance plan. Compliance with applicable CLIA and HIPAA regulations, staying updated with Standard Operating Procedures (SOPs), and adhering to all company and department policies and procedures are crucial. Contributing to a positive work and team culture is also emphasized.
