Authorization Specialist

Westchester Medical Center; Town of Mount Pleasant (NY); On-site; USD 28,000 - 41,000; Full time

Job summary

Westchester Medical Center in New York is seeking an Authorization Specialist to handle complex clerical tasks for verifying insurance information and obtaining authorization for hospital procedures, tests, and office diagnostics. The role focuses on timely processing and preventing denials while maintaining patient confidentiality.

The position requires 1–3 years in healthcare and a high school diploma or equivalent, with prior pre-authorization experience preferred.

Qualifications

• 1–3 years of experience in the health care field.
• Previous experience with the pre-authorization process preferred.
• A high school diploma or equivalency required.

Responsibilities

• Serve as liaison between physicians, office staff, patients and insurance carriers regarding the authorization process.
• Collect and review patient demographic and insurance data for accuracy during authorization.
• Collect and submit documentation and diagnosis needed for authorizations.
• Notify providers of peer-to-peer reviews for denials and arrange them as needed.
• Provide daily follow-up with insurance carriers to update the status of authorization requests.
• Adhere to policy to prevent denials or patient delays.
• Perform eligibility checks on insurance payer websites.
• Review daily processed authorizations and outstanding items.
• Log deliveries of medications from Specialty pharmacies and notify relevant staff.

Education

High school diploma or equivalent

Job description

Job Summary:

The Authorization Specialist is responsible for performing complex clerical procedures related to verifying insurance information and obtaining authorization for hospital procedures and tests as well as office diagnostic testing in accordance with established rules and procedures, specified time frames and regulatory requirements. The employee processes clinical information in a timely, efficient manner to prevent treatment delays and to avoid denials from third party payers and maintains confidentiality of patient information.

Responsibilities:

• Serves as liaison between physicians, office staff, patients and insurance carriers regarding the authorization process. .
• Collects and reviews for accuracy patient demographic and insurance data as part of the authorization process.
• Collects and submits all documentation and diagnosis needed for Authorizations.
• Advises physicians, surgical coordinatorss practice administration of problems with insurance authorizations and resubmits requests with additional or revised information as needed.
• Notifies provider of the need for peer-to-peer reviews for problem cases which have been initially denied authorization for services and will assist with the arrangement of same.
• Provides daily follow-up with the authorization departments of the various insurance carriers for an update of the status of the various authorization requests to ensure optimum delivery of services.
• Adheres to the policy to prevent denials or patient delays
• Performs eligibility checks on insurance payers internet websites and RTE
• Effectively utilizes automated systems to perform work assignments
• Continually reviews diagnostic testing schedules at multiple locations to capture any changes, i.e., add on testing to the various schedules.
• Reviews daily what authorizations for procedures have processed and what is outstanding.
• Logs in deliveries of medications received from Specialty pharmacies on a daily basis and notifies appropriate person via EMR and in person.
• Performs other tasks as assigned

Qualifications/Requirements:

Experience:

1-3 years of experience in the health care field is required. Previous experience with the pre-authorization process preferred.

Education:

A high school diploma or equivalency required.