Authorization Specialist

Westchester Medical Center Health Network; Town of Mount Pleasant (NY); On-site; USD 52,000 - 68,000; Full time

Job summary

Westchester Medical Center Health Network is seeking an Authorization Specialist to verify insurance information and obtain authorizations for hospital procedures and tests, ensuring timely processing and protecting patient care from delays. The role emphasizes handling documentation, liaising with physicians and insurance carriers, and maintaining patient confidentiality across multiple locations.

The candidate will collect and review demographics, submit necessary records for authorizations,

Qualifications

• 1-3 years of experience in the health care field is required.
• High school diploma or equivalency required.

Responsibilities

• Acts as liaison between physicians, office staff, patients and insurance carriers regarding authorization.
• Collects and reviews patient demographics and insurance data for authorization.
• Submits documentation and diagnoses needed for authorizations; notifies provider of processing status.
• Provides follow-up with insurer authorization departments to ensure timely approvals and avoid delays.
• Performs eligibility checks on payer websites and EMR systems.
• Monitors diagnostics schedules across locations for authorization changes.

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.