Authorization Specialist

seniorpsych; Houston (TX); On-site; USD 42,000 - 63,000; Full time

Job summary

seniorpsych in Houston seeks an Authorization Specialist to obtain required pre-authorizations and help process referrals for all services accurately and timely. You will work with healthcare providers and payers, review medical documentation, and follow coding guidelines to ensure proper authorization.

Ideal candidates understand ICD-10/CPT coding, insurance verification, and pre-authorization workflows, and can operate independently or within a team to resolve issues and improve workflows.

Qualifications

• Experience with prior authorization workflows.
• Familiarity with ICD-10 and CPT codes.
• Strong attention to detail and organization.
• Ability to collaborate with providers and payers.

Responsibilities

• Prioritize authorization requests by urgency.
• Initiate and complete the authorization/referral process.
• Resolve day-to-day issues related to pre-authorization.
• Monitor provider network status and follow up on pending cases.
• Obtain authorizations via fax, payer website, or phone.
• Notify departments for approvals and denials.
• Assist with denials appeals when needed.
• Maintain payer policy guidelines to manage authorization requirements.
• Submit patient documents to ensure approval.
• Collaborate with providers and insurers to resolve issues.

Skills

Prior authorization

Insurance verification

ICD-10 coding

CPT coding

Communication

Teamwork

Job description

JOB DESCRIPTION

SeniorPsychCareishiring foranAuthorization Specialist.The position isprimarily responsible for obtaining requiredpre-authorizations andhelping to processreferrals for all services accurately andtimely.

ESSENTIAL FUNCTIONS

• Prioritize incoming authorization requests according to urgency
• Initiate,verify, and complete procedure authorization/referral process
• Resolves day-to-day issuespertaining topre-authorization, as needed
• Monitor provider network status
• Obtain authorization by fax, payer website or by phone and follow up regularly on pending cases.
• Notify appropriate departmentsfor approvals and denials
• Initiate andassistwith appeals for denied authorizations
• Effectivelymaintain, monitor, and update payer medical policy guidelines to manage authorization requirements
• Request, review, andsubmitnecessary patient documentation as neededto ensure approval of authorization
• Collaborate with healthcare providers and insurance companies to resolve any issues related to prior authorization
• Stay current with changing insurance policies and regulations
• EffectivelyutilizesICD 10, CPT,modifiers, and/or other codes according to coding guidelineswhen requesting Authorizations
• Communicates effectively with the provider and/or allappropriate partiesregardingmissing information, such as CPT,diagnosis codes, documents, clinical reports, etc., to ensure proper authorization processing
• Communicates effectively with other departmentsregardingchanges and/or updates with patient accounts andstatus
• Manages the status of accounts andidentifiesinconsistencies
• Responds to billing inquiries
• Uses downtime efficiently; is aware of team members' workload
• Makes recommendations on workflow improvement as needed

KNOWLEDGE, SKILLS, AND ABILITIES

• Knowledge of in and out of network insurance, insurance verification, and the process for prior authorization
• Familiarity with ICD-10 and CPT codes and procedures
• Ability to review and understand patient medical documentation
• Ability to independentlyidentifyand understand medical necessity requirements
• Task-oriented and organizational skills; ability to complete tasksimely manner
• Detail-oriented focus; being careful about detail and thorough in completing work tasks
• Ability to work independently and as a team