Authorization Specialist SSC

Lincare Holdings; Kenilworth Estates (TN); On-site; USD 35,000 - 52,000; Full time

Job summary

Lincare Holdings in the United States seeks an Authorization Specialist to prioritize and manage prior authorizations for medications and services. You will work directly with patients, doctors’ offices, and insurers to collect documentation and submit requests.

Responsibilities include reviewing charts, tracking authorizations, resolving denials, preparing appeal letters, coding with ICD-10, and documenting communications in compliant records.

Qualifications

• High School Diploma or GED required.
• Strong knowledge of medical terminology and HIPAA regulations.
• Experience communicating with patients, physicians, and insurers.

Responsibilities

• Prioritize incoming prior authorization requests.
• Evaluate and triage prior authorization rejections for validity.
• Communicate with patients regarding clinical information for submissions.
• Review patient charts to ensure accuracy of prior authorizations submissions.
• Request, track, and obtain prior authorizations from insurers within required time frames.
• Follow up on submitted authorizations with insurers when needed.

Skills

Medical terminology

HIPAA compliance

Communication

Education

High School Diploma or GED

Tools

AS400

LITE

Job description

This employee verifies insurance, obtaining authorizations and documents needed to confirm order; responsible for communicating directly with the patient, doctors' offices, insurance companies, and centers associated with the patient's account.

Job Responsibilities

• Prioritize incoming prior authorization requests
• Evaluate and triage prior authorization rejections to determine validity of the prior authorization
• Communicate as needed with patients regarding clinical information to be used when submitting the prior authorization
• Review patient chart documentation to ensure accuracy of prior authorization submissions
• Request, track, and obtain prior authorization from insurance carriers within time allotted for medical and services using my meds, fax, or verbal communication
• In a timely manner, follow up on prior authorizations that have been submitted with no response from the insurance carrier
• When justifiable, initiate appeals for denied authorizations
• Maintain patient files on Prior Authorizations tracker
• Compose letters for various situations to include medical necessity letters and appeal letters
• Use ICD-10 diagnosis codes accurately and properly in the submission of prior authorizations
• Contact patients via the platform to update the status of their prior authorization
• Assist patients with medication assistance programs to include obtaining signatures from providers, submit documentation to medical assistance programs, and tracking progress
• Demonstrate and apply knowledge of medical terminology
  • high proficiency of general medical office procedures including HIPAA regulations
• Communicate with pharmacies/insurance carriers via phone, fax, or written communication
• Maintain a level of productivity suitable for the department
• Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format
• Evaluate options and make efficient decisions
• Maintain consistently accurate records
• Proficiency with multiple programs that include the use of internet and email
• Learn how to use new software
  • AS400
  • LITE

Education and Experience

• High School Diploma or equivalent (GED) required

Physical Demands

The employee may frequently lift and/or move up to 10 pounds and may occasionally lift and/or move up to 25 pounds.