Authorization Specialist

Conway Medical Center; Conway (SC); On-site; USD 25,000 - 36,000; Full time

Job summary

Conway Medical Center is seeking an Authorization Specialist to determine if authorizations are required for orders and to verify patient insurance details for accurate reimbursement.

You will review demographics, manage insurance information, educate patients on coverage, and work with frontline staff to secure timely payments.

The role requires 2 years in hospital/physician billing or pre-authorization, familiarity with EHR systems, and knowledge of Medicare/Medicaid, HMOs, and PPOs.

Qualifications

• Requires High School Diploma; preferred healthcare certification(s).
• 2 years hospital/physician billing, pre-authorization, or insurance verification experience.
• Knowledge of Medicare/Medicaid, HMO/PPO networks required.
• Familiarity with EHR systems and insurance eligibility tools.

Responsibilities

• Collaborates with designated clinical contacts for escalation to peer-to-peer review.
• Facilitates submission of clean claims and reduces payer denials by following policies.
• Educates and counsels patients on insurance coverage and payment options.
• Works with front-line staff to secure collections at time of presentation.
• Demonstrates exemplary customer service and clear written and verbal communication.
• Proficient with PC/technology and able to thrive in a fast-paced environment.
• Performs other duties as assigned by department leadership.

Skills

Communication skills

Customer service

Attention to detail

Healthcare insurance knowledge

Education

High School Diploma

Associate degree in ICD-10-CM/ICD-10-PCS

Certified Health Access Associate credential

CPT, HCPCS certification preferred

Job description

Full Time , Primarily 1st Shift- Days , 80

Position Summary:

The Authorization Specialist (AS) is assigned patients to obtain insurance to determine if an authorization is required for the testing/procedure being ordered by the requesting physician/practitioner. The Authorization Specialist AS will check patient demographics and more importantly insurance information to ensure Conway Medical Center has the most up-to-date information for accurate reimbursement submission.

Qualifications

Education:

• High School Diploma required.

Experience:

Two (2) years’ experience in hospital and/or physician billing/pre-authorization or insurance verification.

Demonstrated knowledge of health insurance plans including: Medicare; Medicaid, HMO’s; and PPO’s required.

Familiarity with electronic health records (E.H.R.) and documentation requirements and accessibility.

Knowledge of online insurance eligibility and insurance verification systems.

Licensure/Certification/Registration:

• Medical Terminology certification preferred.
• Certification or Associate degree in ICD-10-CM/ICD-10-PCS; CPT, HCPCS preferred
• Certified Health Access Associate credential preferred

Duties & Responsibilities:

• Collaborates with designated clinical contacts that require escalation to peer-to-peer review.
• Facilitates submission of clean claims and reduction in payer denials by adhering to both organizational and departmental policies and procedures and maintaining departmental productivity and quality goals.
• Educate and counsel patients on their insurance coverage and explain payment options that are available to them.
• Work with front line staff to ensure collections are secured at time of presentation.
• Always displays exemplary core customer service skills.
• Consistently display effective verbal and written communication skills.
• Proficient understanding and use of technology/PC skills required.
• Work well in a fast-paced environment; efficiently organize work and maintain a high level of accuracy and productivity.
• Completeother duties as assigned by department leadership.