Authorization Specialist SSC

Lincare Holdings Inc.; Nashville, Northern (TN, KY); Hybrid; USD 42,000 - 68,000; Full time

Job summary

Lincare is seeking an insurance prior authorization specialist to verify authorizations and collect necessary documents. You will communicate directly with patients, doctors’ offices, insurance companies, and centers associated with the patient’s account.

Responsibilities include triaging rejections, submitting authorizations, tracking status, following up, preparing letters, using ICD-10 codes, and assisting patients with medication assistance programs while ensuring HIPAA compliance.

Qualifications

• High School Diploma or GED required.

Responsibilities

• 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

Skills

Decision making

Record keeping

Internet & email

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:

• 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

Qualifications.

• 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.

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Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
Lincare is an equal opportunity employer, access and affirmative action employer. All qualified applicants will receive consideration for employment regardless of race, color, religion, creed, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Lincare provides reasonable accommodations for qualified individuals with disabilities. Because Lincare believes in providing a safe work environment, we conduct drug and background checks in our recruiting/hiring processes. AA/EOE, M/F/Disabled/Veterans