Medical Authorization Specialist

Bioventus•Memphis, TN

26d

About The Position

The Medical Authorization Specialist (MAS) supports Bioventus’ reimbursement strategy by pursuing authorization and reimbursement and serving as a resource of expertise to payers. The specialist reviews medical records and applies payer-specific criteria to assess medical necessity or clinical appropriateness for company products. The role submits timely pre-authorization requests with supporting documentation, maintains accurate patient insurance and billing information, and helps ensure patient data is handled securely and compliantly. The specialist also coordinates with the Order Management team to obtain additional information and medical documentation from patients and prescribing healthcare providers.

Requirements

High school diploma plus four years of related experience, or a four-year college degree.
One year of medical authorization experience involving medical record review.
Knowledge of and ability to interpret medical terminology and ICD-10 coding.
Good written and oral communication skills and ability to interface with customers and company personnel at all levels.
Strong persuasion and negotiation skills.
Professional persistence, ability to manage detailed information, strong organization, and proficiency in multitasking and managing time and priorities.
PC experience with Microsoft Word, Excel, Outlook, or related software.

Nice To Haves

Knowledge of SAP or other integrated software applications.

Responsibilities

Review and interpret medical record documentation for patient history, diagnosis, and previous treatment plans.
Use payer-specific approved criteria to determine medical necessity or clinical appropriateness for company products.
Submit demographic and supporting clinical documentation with pre-authorization requests in a timely manner.
Maintain and document complete, timely, and accurate patient insurance and billing information.
Perform ongoing checks and balances to ensure the integrity of patient billing data.
Protect and maintain the confidentiality and security of patient data and comply with company policies and procedures.
Work with the Order Management team to obtain additional information and medical documentation from patients and prescribing healthcare providers.
Comply with applicable health, safety, and environmental policies, procedures, and job hazard analyses, including required medical evaluations.
Complete required training in a satisfactory and timely manner.
Conduct business in compliance with Bioventus’ Code of Compliance, policies, procedures, and applicable internal controls, and hold oneself and others accountable to do so.
Perform other duties as assigned.