Job description
Clinic Authorization Specialist
REPORTS TO: Clinic Manager/ Director
DEPARTMENT: Warrensburg Internal Medicine
JOB SUMMARY
Responsible for verifying and obtaining authorizations as required by insurance company’s dependent upon the plan coverage for all patients.
ESSENTIAL FUNCTIONS:
- Assist in educating and acts as a resource to clinicians and support staff regarding authorizations
- To assure all pre-authorizations have been approved with the proper procedure code prior to service being rendered
- Responsible for pending claims reports on claims received without prior authorization to research and review eligibility and benefit coverage. Upon decision of claim payment status, generates the appropriate referral with notification and exchange of information to the service organization for proper adjudication of claim payment
- Provide data entry for proper level of care which has been arranged by the Authorization received from funding sources
- Contact providers with authorization, denial and appeals process information
- Research and work with patient access and billing departments in researching and resolving rejected, incorrectly paid, or denied claims as requested
- Ability to perform all other duties as assigned or requested by clinic manager
- Greet patients and visitors in a courteous and friendly manner
- Ensure proper flow of patient throughout the clinic.
- Perform insurance verifications on a daily basis
- Perform patient check in and check out, instructs patients on payment requirements and collects all co-pays and payments due at the time of service
- Prep next day’s charts to ensure proper referral and incoming medical information has been obtained.
- Answer all incoming call and routes to proper extensions
- Maintain regular and predictable attendance
- Perform other essential duties as assigned
EDUCATION/EXPERIENCE/SKILLS REQUIRED:
- High school graduate
- General office work experience (2yrs)
- Computer and EMR experience
- Medical terminology- Preferred
- Organizational skills
- Advanced typing skills
- Communicate well with people both in personal contact and in telephone conversations
- Effectively act as a liaison between patients and physicians
- Follow oral and written instructions
- Familiar with medical office practices and medical insurance
- Familiar with ICD-10, CPT, HCPCS codes
- Excellent interpersonal skills required to communicate with direct staff and funding sources.
- Must possess excellent time management and organizational skills.
- Demonstrated critical thinking, creativity, problem solving and decision-making skills.
- Working knowledge of federal, state, local and intermediary specific billing requirements to ensure appropriate authorizations are completed and/or notifies appropriate person of missing or incomplete billing requirements and follows up in a timely manner.
- Maintaining current knowledge and understanding of government rules, regulations.
- Ability to work with technology necessary to complete job effectively.
- Must be knowledgeable of current changes in coding and reimbursement requirements for all billing payors.
- Must be self-motivated and have the ability to work within the established policies, procedures and practices prescribed by the hospital/clinic.
FULL-TIME/PART-TIME
Full-Time
SHIFT
Days
EXEMPT/NON-EXEMPT
Non-Exempt
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