Authorization Specialist at Chicago ENT Chicago, IL

Comunidade Metodista; Chicago (IL); On-site; USD 42,000 - 60,000; Full time

Job summary

The Comunidade Metodista seeks an Authorization Specialist to manage pre-certification and pre-authorization for procedures, treatments, and tests. You will communicate with patients, families, and internal staff about authorization statuses and requirements, while maintaining strict confidentiality and accuracy in EMR records.

In this role you will verify benefits, submit necessary codes, coordinate with providers, and track approvals from start to finish, ensuring timely authorizations and

Qualifications

• Two years of medical insurance verification and authorization experience.
• Excellent organizational skills and attention to detail.
• Excellent verbal and written communication, and interpersonal skills.
• Excellent time management skills.
• Strong analytical and problem-solving skills.
• Ability to remain calm in stressful situations, to be flexible, to multi-task.
• High level of customer service toward patients and staff.
• Proficiency in completing pre-authorizations via insurance websites.

Responsibilities

• Works directly with insurance companies, Chicago ENT staff/providers, and external referring staff/providers to ensure an efficient authorization process.
• Daily monitors schedules and orders to begin prior authorization.
• Accurately verifies patient insurance/benefits before beginning prior authorization.
• Communicates plan limitations or non-covered services with ordering physician and patient.
• Submits CPT and ICD-10 codes, coordinates necessary clinical information, peer-to-peer calls, and appeals.
• Alerts patients and providers when approved and documents status in the EMR.
• Records authorization/reference numbers in the EMR for billing.
• Answers, screens, and routes phone queries and checks voicemails, faxes, and other communications.
• Cooperates with admin staff, medical staff, other departments, and visitors.
• Reviews denied claims and works with billing to identify processing issues and errors.
• Acts as an expert to answer questions from patients and staff.
• Maintains confidentiality of patient information.
• Performs other selected administrative duties as directed by physicians or Practice Administrator.

Skills

Organization

Communication

Time management

Analytical skills

Customer service

Bilingual (preferred)

Tools

EMR

Job description

AUTHORIZATION SPECIALIST

Our highly professional Authorization Specialist is responsible for pre-certification and pre-authorization for procedures, treatment(s), and testing. The Authorization Specialist has a high proficiency for communicating internally as well as with patients and their families regarding the needs/status of prior authorization. This position reports to the Practice Administrator.

PRIMARY RESPONSIBILITIES

• Works directly with the insurance companies, Chicago ENT staff/providers, and external referring staff/providers to ensure an efficient authorization process.
• Daily monitors schedules and orders to begin prior authorization.
• Accurately verifies patient insurance/benefits before beginning prior authorization.
• Communicates plan limitations or non-covered services with ordering physician and patient.
• Monitors prior authorization from initiation to completion:
  • Submits all ordered CPT and ICD-10 diagnosis codes.
  • Submit necessary clinical information, coordinate peer-to-peer calls, and appeals denied authorizations.
  • Once approved, alerts the patients and providers, and documents status on EMR appointment.
  • Records prior authorization/reference numbers in the EMR for billing department.
• Answer, screen, respond, and rout phone queries in addition to checking voicemails, telephone encounters, faxes, and other inbound communication.
• Cooperate and maintain good rapport with admin staff, medical staff, other departments, and visitors.
• Review denied claims and proactively work with billing to identify processing issues and errors.
• Act as an expert to answer questions from patients and staff.
• Maintain a professional approach with confidentiality regarding all patient information.
• Performs other selected administrative duties as directed by physicians or Practice Administrator.

REQUIRED QUALIFICATIONS

• Two years of medical insurance verification and authorization experience.
• Excellent organizational skills and attention to detail.
• Excellent verbal and written communication, and interpersonal skills.
• Excellent time management skills.
• Strong analytical and problem-solving skills.
• Must have the ability to remain calm in stressful situations, to be flexible, to work well with many interruptions and to be able to multi-task.
• Must exhibit and promote a high level of customer service, hospitality, curiosity and friendliness towards all patients, employees, and the overall facility.
• Bilingual preferred.
• Proficiency in completing pre-authorizations via insurance web sites.

SUPERVISORY RESPONSIBILITY

This position has no supervisory responsibility.

CERTIFICATES, LICENSES, REGISTRATIONS

None required.

ENT is a drug-free environment and an Equal Opportunity Employer. We offer competitive salaries and benefits, including medical/dental, life and disability coverage, generous vision benefits, a 401 (k) plan with a match, vacation time, and weekends and major holidays off.