Authorization Specialist

OSS Health; Pennsylvania; On-site; USD 40,000 - 60,000; Full time

Benefits offered by this job

Competitive Wages

Medical, Dental, Vision first day

Disability and Life Insurance within 3

Company-Paid Group Life Insurance and

Job summary

OSS Health is seeking an Authorization Specialist to verify benefits/eligibility and obtain authorizations for visits, procedures, surgery, and testing, interfacing with payors, clinicians, and patients.

Ideal candidates have medical terminology knowledge, CPT/ICD10 familiarity, strong communication, and experience with EMR systems. Schedule is Monday–Friday, 8:00am–4:30pm, with OSS Health.

Qualifications

• One-year relevant experience in the medical field or prior authorization required.
• Knowledge of CPT/ICD10 for insurance verification and medical procedures.
• Strong clinical knowledge and anatomy; orthopedic knowledge preferred.
• Detail oriented with excellent organizational and prioritizing skills.

Responsibilities

• Screens and analyzes medical records for medical necessity for authorization.
• Obtains patients' benefit information from insurers.
• Coordinates with OSS and external staff to secure authorization.
• Documents results in EMR and supports claims processing.
• Maintains confidentiality and professional communication with patients and insurers.
• Meets deadlines and adheres to audit standards.

Skills

Medical terminology

CPT/ICD-10 knowledge

Microsoft Office

Analytical thinking

Strong communication

Independent work

Phone etiquette

Education

High School Diploma or equivalent

LPN or certified Medical Assistant

Tools

EMR systems

Job description

JOB SUMMARY

The basic function of the Authorization Specialist is to verify benefits/eligibility and obtain authorizations when necessary for visits, procedures, surgery, treatment, and testing with the patient’s corresponding insurance company as authorized by the physician. The Authorization Specialist will serve as a liaison between the clinical team, provider, outside facilities and the patient.

SCHEDULE

Monday - Friday 8:00am - 4:30pm

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Screens and analyzes the patient’s medical records for the documentation and criteria required to meet medical necessity for the authorization process.
• Obtains patients benefit information from the insurance company.
• Familiarizes self with medical policies and criteria for each insurance company.
• Follows up in a timely manner with the doctor’s team if additional information is needed.
• Reviews clinical documents with Nurse Reviewers and/or Utilization Managers at various insurance companies and third-party administrators.
• Coordinates with other OSS department staff, external facility staff and external companies to ensure authorization/referral is obtained.
• Communicates with external locations to ensure shipment of injection to OSS.
• Ensures authorization is secured with the insurance company prior to scheduled service.
• Obtains authorization timely when the service requires an auth prior to scheduling.
• Contributes to the development and delivery of team training initiatives.
• Communicates with physician’s team to notify patients when unsuccessful at obtaining pre-certification/authorization.
• Documents the results of the process in the EMR systems for future reference and for claims processing.
• Addresses concerns of insurance companies as well as patients in a professional, calm and understanding fashion.
• Maintains an orderly and neat work area.
• Maintains confidentiality and always protects sensitive data, including and not limited to patient information.
• Maintains performance in alignment with audit standards set by the team/department.
• Creates and modifies vendor reports.
• Other duties as assigned.

EDUCATION

• High School Diploma or equivalent required; Licensed Practical Nurse (LPN) or certified Medical Assistant (MA) highly preferred.

EXPERIENCE / QUALIFICATIONS

• One-year relevant experience in the medical field or in prior authorization required.
• Must have basic knowledge and understanding of CPT/ICD10 codes for insurance verification. Must have basic knowledge and understanding of medications, advanced imaging studies and surgical procedures.
• Must have strong clinical knowledge and understanding of medical terminology and anatomy. Orthopedic knowledge is preferred.
• Must have proficient computer skills, including Microsoft Office, and skills utilizing basic office equipment.
• Must be detail oriented, have excellent organizational and prioritizing skills and be able to meet competing deadlines.
• Must possess a high level of analytical skills and critical thinking.
• Must be able to work independently. Must be able to demonstrate initiative to provide quality and improve efficiency with an assigned workload.
• Must have excellent communication skills, both written and verbal, to ensure communication is accurate.
• Must have good telephone etiquette, and be able to answer the phones, identify self and direct calls appropriately.
• Must be able to demonstrate flexibility by adapting to new and changing duties to meet patient needs effectively and with efficiency.

BENEFITS INCLUDE

• Competitive Wages
• Medical, Dental, Vision available on the first day of employment
• Disability, and Life Insurance within 90 days
• Company-Paid Group Life Insurance, Short-Term Disability & Long-Term Disability
• Paid Time Off (PTO)
• 401(k) plan and profit sharing
• Career Advancement Opportunities