Authorization Specialist

optioncare; Tallahassee (FL); On-site; USD 23,000 - 39,000; Full time

Job summary

Option Care Health, Inc. is seeking an Authorization Specialist to submit accurate and timely requests to insurers, set up patient accounts, and verify medical necessity.

You will work with healthcare providers and payers, using basic medical coding and terminology, ensuring completeness and compliance. Responsibilities include maintaining patient records, tracking authorizations, and collaborating with billing and claims teams to resolve issues.

Qualifications

• High school diploma is required.
• Ability to multi-task and support numerous referrals/priorities.

Responsibilities

• Submit accurate and timely authorization requests to insurance companies and payers.
• Ensure proper setup and maintenance of patient accounts in the system.
• Obtain and review clinical documentation to verify medical necessity.
• Communicate with healthcare providers to gather required information for authorizations.
• Verify insurance benefits and eligibility for services.
• Monitor the status of authorization requests and follow up as needed.
• Ensure compliance with payer requirements and regulations.
• Utilize basic medical coding, diagnosis codes, and medical terminology in the authorization process.
• Maintain detailed records and documentation for all authorizations.
• Collaborate with billing and claims teams to resolve any authorization-related issues.

Skills

Multi-tasking

Attention to detail

Organizational skills

Education

High school diploma or equivalent

Job description

Extraordinary Careers. Endless Possibilities.

With the nation's largest home infusion provider, there is no limit to the growth of your career.

Option Care Health, Inc. is the largest independent home and alternate site infusion services provider in the United States. With over 8,000 team members including 5,000 clinicians, we work compassionately to elevate standards of care for patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the infusion care experience for patients, customers and team members.

Job Description Summary

Submits accurate and timely authorization requests to ensure proper reimbursement for patient services. This role involves setting up patient accounts, obtaining necessary clinical documentation, and verifying medical necessity. The specialist must have a solid understanding of basic medical coding, diagnosis codes, and medical terminology. Strong attention to detail, organizational skills, and the ability to work collaboratively with healthcare providers and payers are essential for success in this role.

Job Responsibilities (listed in order of importance and/or time spent)

• Submit accurate and timely authorization requests to insurance companies and payers
• Ensure proper setup and maintenance of patient accounts in the system
• Obtain and review clinical documentation to verify medical necessity
• Communicate with healthcare providers to gather required information for authorizations
• Verify insurance benefits and eligibility for services
• Monitor the status of authorization requests and follow up as needed
• Ensure compliance with payer requirements and regulations
• Utilize basic medical coding, diagnosis codes, and medical terminology in the authorization process
• Maintain detailed records and documentation for all authorizations
• Collaborate with billing and claims teams to resolve any authorization-related issues

Supervisory Responsibilities

Does this position have supervisory responsibilities? (i.e. hiring, recommending/approving promotions and pay increases, scheduling, performance reviews, discipline, etc.)

No X

Basic Education and/or Experience Requirements

High school diploma or equivalent is required.

Basic Qualifications

• Ability to multi-task and support numerous referrals/priorities at one time.
• Ability to work in a fast past environment.
• High degree of self-discipline in maintaining productivity expectations.
• Must be detail-oriented and have a high degree of quality focus.

Travel Requirements: (if required)

N/A

Preferred Qualifications & Interests (PQIs)

Healthcare/medical billing experience preferred.

This job description is to be used as a guide for accomplishing Company and department objectives, and only covers the primary functions and responsibilities of the position. It is in no way to be construed as an all-encompassing list of duties

May perform other duties as assigned

Benefits

• Medical, Dental, & Vision Insurance
• Paid Time off
• Bonding Time Off
• 401K Retirement Savings Plan with Company Match
• HSA Company Match
• Flexible Spending Accounts
• Tuition Reimbursement
• myFlexPay
• Family Support
• Mental Health Services
• Company Paid Life Insurance
• Award/Recognition Programs

Due to state pay transparency laws, the full range for the position is below:

Pay Range is $17.02-$28.38

Option Care Health subscribes to a policy of equal employment opportunity, making employment available without regard to race, color, religion, national origin, citizenship status according to the Immigration Reform and Control Act of 1986, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information.