Authorization Specialist — Healthcare Claims & EMR Expert

Remote Jobs; Durham (NC); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

401(k) Retirement plan

Health Insurance

Dental Insurance

Vision Insurance

Flexible spending account

Health savings account

Paid time off

Holiday Pay

Employee Assistance Program

Life Insurance

Short Term Disability

Long Term Disability

Pet Insurance

Milestone Bonus Program

Job summary

EmergeOrtho is seeking an Authorizations Specialist to obtain and apply all required authorizations for medical claims in North Carolina. The role ensures insurance eligibility is confirmed and acts as a liaison among physicians, case managers, adjusters, and social workers to secure necessary authorizations.

The position requires a high school diploma, experience in insurance billing and coding, and at least two years in patient services within healthcare.

Qualifications

• High school diploma or equivalent.
• Experience in insurance billing and coding.
• Minimum two years of patient service experience in a healthcare setting.
• Ability to act with integrity, professionalism, and confidentiality.
• Experience using electronic medical records systems.
• Excellent communication and interpersonal skills.
• Excellent organizational skills and attention to detail.

Responsibilities

• Obtains orders from the physician.
• Log all orders in EMR for accurate tracking and scheduling.
• Eligibility, benefits, and authorization are obtained online or via telephone.
• Respond to clinical requests by providing accurate information. Perform follow-up calls within 3 business days regarding the authorization status.
• If a peer-to-peer review is needed prior to obtaining authorization, we will schedule with our physician and the insurance carrier's Medical Director.
• If the request is to have the patient be sent to an outside physician for treatment the office notes, patient demographics, and insurance card(s) are faxed to the outside physician's office for an appointment.
• Follow up on requests within 7-10 days to confirm accurate information has been received and confirm an appointment has been made.
• Work diagnostic orders within 3-5 days of receipt. STAT orders are worked on immediatelyObtain surgical authorizations 10 days prior to the surgery date unless the surgery is scheduled as a STAT
• Maintain the electronic log sheet, generated for physical therapy patients indicating patient demographics and therapy caps.
• Maintains clinic and patient confidentiality.
• Performs other duties as required and assigned by Manager, including schedule changes and travel to office locations as assigned

Skills

Communication skills

Organizational skills

Attention to detail

Confidentiality

Interpersonal skills

Education

High school diploma or equivalent

Tools

EMR systems

Job description

EmergeOrtho is seeking an Authorizations Specialist to obtain and apply all required authorizations for medical claims in North Carolina. The role ensures insurance eligibility is confirmed and acts as a liaison among physicians, case managers, adjusters, and social workers to secure necessary authorizations.

The position requires a high school diploma, experience in insurance billing and coding, and at least two years in patient services within healthcare.