Authorization Specialist

Canyon-Home-Care-and-Hospice-1; Loveland (CO); On-site; USD 42,000 - 52,000; Full time

Job summary

Canyon Home Care & Hospice is seeking a detail-oriented Authorization Specialist for our Loveland, CO office. You will verify patient eligibility, obtain authorizations for scheduled exams, and gather supporting clinical data to ensure timely payments from accepted payers.

Responsibilities include managing preauthorization, contacting patients for updated information, and coordinating with health plans to maintain high approval rates while keeping all teams aligned on patient insurance data.

Qualifications

• Current knowledge of medical terminology, insurance authorization and verification.
• Knowledge of ICD-Codes/CPT preferred.
• Strong technical skills (Word, Excel, Acrobat or similar product).
• Successful completion of or ability to complete state continuing education requirements.
• Excellent verbal and written communication skills and strong interpersonal skills.
• Ability to work in a fast paced setting.
• Knowledge of regulatory requirements at federal, state and local levels.
• At least 21 years of age.

Responsibilities

• Manage predetermination, authorization, and referral requirements for each health plan.
• Contact patients/referring offices for updated insurance information and records.
• Ensure that exams are authorized 48 hours prior to the date of service.
• Ensure same-day add-ons are authorized within 24 hours after exam completion.
• Coordinate with health plans to provide medical records and data to ensure 99% approval rate.
• Communicate with internal departments to keep patient insurance info accurate.

Skills

Medical terminology

Insurance authorization

Verification

Interpersonal skills

Verbal communication

Written communication

Regulatory knowledge

Fast-paced work

Tools

Word

Excel

Acrobat

Job description

Canyon Home Care & Hospice is growing, and we need great people to join us! We are looking for a full-time Authorization Specialist to work in our Loveland office. The right person will be detail-oriented, able to utilize technology effectively, work well in a busy office environment, and be dedicated to connecting patients with high-quality care.JOB SUMMARYThe Authorization Specialist is responsible for the day-to-day processes to verify patient eligibility andobtain authorization for all exams scheduled to ensure timely payments from all accepted payer. Thetypical daily work load consists of the following: eligibility investigations via phone and online webportals, obtaining authorizations, collecting supporting clinical data from patients and/or referring offices andupdating all information.RESPONSIBILITIESManage the predetermination, authorization, and referral requirements of each health plan and meeting the requirements prior to the delivery of services.Contacts patients and/or referring offices for updated insurance information, medical records and/or additional clinical data to ensure that no more than 5% of all exams end up in pending clinical.Cross reference daily schedule and work queue to ensure that all scheduled exams are authorized forty-eight (48) hours prior to the date of service.Cross reference daily schedule and work queue to ensure that all same day add-ons are authorized prior to the completion of the exam; other payers must be authorized within twenty-four (24) hours following the completion of the exam.Work with each health plan to provide medical records and/or additional clinical data to ensure that 99% of all completed exams are approved for payment.Communicate and coordinate effectively with internal departments to ensure patient insurance information is accurate and updated.QUALIFICATIONSCurrent knowledge of medical terminology, insurance authorization and verification.Knowledge of ICD-Codes/CPT preferred.Strong technical skills (Word, Excel, Acrobat or similar product).Successful completion of or the ability to successfully complete any state required continuing education requirements.Excellent verbal and written communication skills and strong interpersonal skills.Ability to work in a fast paced setting.Knowledge of regulatory requirements at the federal, state and local levels, as well as knowledge of Agency policies and procedures.At least 21 years of age.