Authorization Specialist

Talentify; Conway (SC); On-site; USD 42,000 - 50,000; Full time

Job summary

Conway Medical Center is seeking an Authorization Specialist to assign patients for insurance review to determine if an authorization is required for orders. The role focuses on verifying demographics and up-to-date insurance information to ensure accurate reimbursement submission.

The specialist collaborates with clinical staff, educates patients on coverage and payment options, and strives to minimize payer denials by adhering to policies and procedures in a fast-paced environment at the

Qualifications

• Two years’ experience in hospital/physician billing or insurance verification.
• Knowledge of Medicare, Medicaid, HMOs and PPOs required.
• Familiarity with EHRs and documentation requirements.
• Knowledge of online insurance eligibility and verification systems.

Responsibilities

• Collaborates with clinical contacts requiring escalation to peer-to-peer review.
• Facilitates clean claims submission and reduces payer denials per policies.
• Educate and counsel patients on insurance coverage and payment options.
• Work with front line staff to secure collections at time of presentation.
• Displays exemplary customer service and effective verbal/written communication.
• Proficient with technology/PC skills; maintain accuracy and productivity.
• Complete other duties as assigned by department leadership.

Skills

Insurance verification

Medical terminology

Customer service

Communication

Education

High School Diploma

Tools

EHR systems

Insurance portals

Job description

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.
• Complete other duties as assigned by department leadership.