Insurance Authorization Specialist Full-Time Varied
About The Position
The primary function of this role is to perform telephone and/or online authorization for routine services, contacting care providers, and monitoring concurrent and discharged authorizations. This position also involves performing online data entry and scanning of routine authorizations, continued stay authorizations, and denials. The role requires assisting in gathering information for continued clinical authorization, providing data entry, and contacting case managers/providers with authorization, denial, and appeal process information. The specialist will also assist in educating and acting as a resource to primary care and specialty providers, working closely with case managers, billers, and support teams to accomplish authorization/verification, and obtaining authorization from health plans, IPAs, and medical groups' case managers. Additionally, the role involves working and resolving pended claims received without prior authorization, serving as a subject matter expert for assigned payor(s) as directed by patient access leadership, and performing telephone and/or online authorization for routine services. The specialist will also perform online data entry and scanning of routine authorizations, continued stay authorizations, and denials. Other accountabilities include working effectively with patient access peers and other departments, delivering exemplary customer service, maintaining a high degree of confidentiality, receiving incoming mail with authorizations for extended stays, answering incoming customer service calls, and providing support to the Revenue Cycle work team as assigned.
Requirements
- High School diploma or GED
- 2 years of billing experience for a healthcare facility
- Ability to communicate effectively verbally and in writing.
- Must be able to work in a union environment.
- Current Los Angeles County Fire Card required (within 30 days of employment)
- Assault Response Competency (ARC) required (within 30 days of hire)
Responsibilities
- Assists in gathering information needed to determine continued clinical authorization.
- Provides data entry, as appropriate.
- Contacts case managers/ providers with authorization, denial and appeal process information.
- Assists in educating and acts as a resource to primary care and specialty providers.
- Works closely with case managers, billers and support team to accomplish authorization/ verification.
- Obtains authorization from health plan, IPA, medical group's case managers.
- Works and resolve pended claims received without prior authorization.
- Serve as subject matter expert for assigned payor (s) as directed by patient access leadership while demonstrating broad knowledge of all payors in the hospital portfolio.
- Performs telephone and/ or on-line authorization for routine services, contacting care providers, monitoring concurrent and discharged authorization.
- Performs online data entry and scanning of routine authorizations, continued stay authorization and denial.
- Works effectively with patient access peers and other departments.
- Delivers exemplary customer service in accordance with hospital expectations / guidelines.
- Ability to work with high degree of confidentiality.
- Receive incoming mail with authorizations for extended stays.
- Answer incoming customer service calls.
- Provides support to Revenue Cycle work Team, as assigned.
- All other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
