Authorization Specialist

Westchester Medical Center; Village of Suffern (NY); On-site; USD 52,000 - 76,000; Full time

Job summary

Westchester Medical Center is seeking an Authorization Specialist to perform complex clerical work tied to verifying insurance information and obtaining authorizations for hospital procedures and tests, ensuring timely processing and confidentiality.

You will liaise with physicians, office staff, patients, and insurers, review demographics, collect documentation for authorizations, and coordinate with scheduling offices to prevent delays and denials.

Qualifications

• 1-3 years of experience in the health care field.
• Experience with the pre-authorization process strongly preferred.
• Neurology experience is preferred.

Responsibilities

• Serves as liaison between physicians, staff, patients, and insurance carriers regarding authorization.
• Collects and reviews patient demographic and insurance data for authorization.
• Collects and submits documentation and diagnoses for authorizations.
• Coordinates scheduling with patient placement, registration, and other offices as needed.
• Advises physicians and administration of problems with authorizations and resubmits requests with revised information.
• Notifies providers of peer-to-peer review needs for denied services and assists with arrangements.
• Provides daily follow-up with insurance authorization departments for status updates.
• Performs eligibility checks on insurer websites and completes reporting in systems.
• Maintains policy to prevent denials or patient delays.
• Performs other tasks as assigned.

Skills

Healthcare experience

Authorization process

Neurology exposure

Education

High School Diploma

Job description

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 maintain 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.
• Coordinates patient scheduling with patient placement, registration, and other scheduling offices as needed.
• Advises physicians, billing managers, and practice administrator of problems with insurance authorizations and resubmits requests with additional or revised information as needed.
• Notifies providers 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 payer's 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.
• Performs other tasks assigned.

Qualifications/Requirements:

Experience:

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

Education:

A high school diploma or equivalency required.

Licenses / Certifications:

N/ASpecial Requirements:N/A