Authorization Specialist

Canyon-Home-Care-and-Hospice-1; Tooele (UT); On-site; USD 40,000 - 50,000; Full time

Job summary

Canyon-Home-Care-and-Hospice-1 is seeking an Authorization Specialist to verify patient eligibility and obtain approvals for exams. The role involves contacting patients and referring offices for updated insurance information and supporting clinical data.

You will work to ensure timely authorizations and accurate information across departments. Responsibilities include cross-referencing schedules, securing 48-hour prior authorizations, and coordinating with health plans to maintain high payment

Qualifications

• Familiar with medical terminology and insurance authorization processes.
• Knowledge of ICD-Codes and CPT is preferred.
• Strong written and verbal communication skills and interpersonal abilities.

Responsibilities

• Verify patient eligibility and obtain authorizations for scheduled exams.
• Collect clinical data from patients and referring offices as needed.
• Coordinate with health plans to ensure timely authorizations and approvals.
• Communicate updated insurance information to internal departments.
• Ensure exams are authorized within required timeframes (48 hours prior to service; 24 hours for add-ons).

Skills

MS Office

Medical terminology

ICD-Codes/CPT

Verbal & written communication

Interpersonal skills

Education

Continuing education requirements

Tools

Word

Excel

Acrobat

Job description

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.LINE OF AUTHORITYReports to the Administrative Director EmployeeQUALIFICATIONSCurrent 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.