Authorization-Referrals Specialist III #Full Time

61st Street Service Corporation; Fort Lee (NJ); On-site; USD 38,407 - 49,676; Full time

Job summary

61st Street Service Corporation is seeking a full-time Authorization-Referrals Specialist III in Fort Lee, New Jersey. This position involves verifying insurance policy benefits, securing payer-required referrals and authorizations, and assisting with daily work assignments and staff training. Candidates should have a high school diploma or GED, with a minimum of two years’ experience in a physician’s billing environment. The hourly rate ranges from $27.88 to $36.06, depending on experience and skill set.

Qualifications

• A minimum of 2 years’ experience in a physician’s billing or third payer environment.
• Candidate must demonstrate the ability to navigate managed care eligibility and insurance billing requirements.
• Certified Professional Coder certificate (CPC) is preferred.

Responsibilities

• Verifies insurance coverage via system tools and payer portals.
• Contacts patient and PCP to secure payer required referrals.
• Submits appeals in the event of denial of prior authorizations.

Skills

Understanding of managed care eligibility

Insurance billing requirements

Communication skills

Education

High school graduate or GED

Tools

Epic

Electronic billing systems

Job description

Authorization-Referrals Specialist III #Full Time

The 61st Street Service Corporation provides administrative and clinical support staff for ColumbiaDoctors. This position will support ColumbiaDoctors, one of the largest multi-specialty practices in the Northeast. ColumbiaDoctors’ practices comprise an experienced group of more than 2,800 physicians, surgeons, dentists, and nurses, offering more than 240 specialties and subspecialties.

Job Summary: The Authorization-Referrals Specialist III is responsible for verifying insurance policy benefit information, securing payer required referrals and authorization prior to the patient’s visit, scheduled admission, or immediately following hospital admission. This position is responsible for obtaining accurate and timely pre-authorizations for professional services. The Authorization-Referrals Specialist III is also responsible for assisting management with daily work assignment, staff training, and quality audits.

Job Responsibilities:

• Verifies insurance coverage via system tools, payer portals.
• Confirms provider’s participation status with patient’s insurance plan/network.
• Determines payer referral and authorization requirements for professional services.
• Contacts patient and PCP to secure payer required referral for planned services.
• Documents referral in practice management system.
• Initiates authorization and submits clinical documentation as requested by insurance companies.
• Manage faxes, emails, and phone calls in a timely manner.
• Communicates with surgical coordinators regarding authorizations status or denials.
• Submits appeals in the event of denial of prior authorizations or denial of payment following procedures.
• Calculate and document patient out of pocket estimates and provide to patient.
• Assists Supervisor with special projects and/or tasks.
• Assists Authorization-Referrals Specialist I and II with complex cases pertaining to clearance of payer referrals, authorization or insurance eligibility issues.
• Assist supervisor/manager with distribution of daily work assignments.
• Assist with new-hire training and staff refresher training materials.
• Monitor and replenish the unit’s office supply needs.
• Performs other job duties as assigned.

Job Qualifications:

• High school graduate or GED certificate is required.
• A minimum of 2 years’ experience in a physician’s billing or third payer environment.
• Candidate must demonstrate the ability to understand and navigate managed care eligibility, insurance billing requirements, and obtaining pre-authorizations.
• Certified Professional Coder certificate (CPC) is preferred.
• Experience in Epic and or other of electronic billing systems is preferred.
• Knowledge of medical terminology, diagnosis and procedure coding is preferred.
• Previous experience in an academic healthcare setting is preferred.

Hourly Rate Ranges: $27.88 - $36.06

Note: Our salary offers will fall within these ranges based on a variety of factors, including but not limited to experience, skill set, training and education.

We are an equal employment opportunity employer and we adhere to all requirements of all applicable federal, state, and local civil rights laws.