Authorizations Specialist

Alliance-Orthopedics-; Bloomfield (NJ); Hybrid; USD 71,635,000 - 74,528,000; Full time

Benefits offered by this job

401(k) matching

Health insurance

Paid time off

Paid Holidays

Job summary

Alliance Health System is seeking an Authorizations Specialist to obtain prior authorizations for treatments, working remotely or in a hybrid setup. The role reports to the Director of Authorizations and requires familiarity with CPT/ICD-10 coding and payer guidelines.

Responsibilities include reviewing documentation, prioritizing requests, submitting authorizations, maintaining payer files, and initiating appeals when needed.

Qualifications

• Knowledge of treatment authorization and its impact on revenue cycle.
• Ability to apply payer guidelines to obtain authorizations.
• Proficiency with CPT and ICD-10 codes and payer portals.

Responsibilities

• Review chart documentation to ensure policy adherence.
• Prioritize authorization requests by urgency.
• Obtain authorizations via payer portals, fax or phone and follow up.
• Maintain payer files with up-to-date requirements.
• Initiate appeals for denials or modifications.
• Answer clinic questions on payer medical policies; validate CPT/ICD-10 accuracy.
• Perform other duties as assigned.

Skills

CPT codes

ICD-10 codes

Payer guidelines

Excel

Customer service

Time management

Attention to detail

Education

High School Diploma or GED

2 years medical prior authorization experience

2 years MD provider experience - Orthopedics & Pain

Tools

Adobe Acrobat

Job description

Authorizations Specialist

Department: RCM: Authorizations

Employment Type: Full Time

Location: Bloomfield

Compensation: $25.00 - $26.00 / hour

Description

Authorizations Specialist

Location: REMOTE or HYBRID
Entity: Alliance Health System
Reports To: Director of Authorizations

Authorization Specialist is responsible for obtaining prior authorizations for all treatment by successfully completing the authorization process with all commercial, automobile and workers compensation payers.

Summary of Responsibilities & Benefits

RESPONSIBILITIES

• Review chart documentation to ensure patient meets medical policy guidelines
• Prioritize incoming authorization requests according to urgency
• Obtain authorization via payer website, fax or by phone and follow up regularly on pending submission
• Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
• Initiate appeals for denied or modified authorizations
• Respond to clinic questions regarding payer medical policy guidelinesConfirm accuracy of CPT and ICD-10 diagnoses in the procedure order
• Other duties as assigned

KNOWLEDGE, SKILLS, AND ABILITIES

• Knowledge of treatment authorization and its direct impact on the practice's revenue cycle
• Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively
• Proficient use of CPT and ICD-10 codes
• Excellent computer skills including Adobe, Excel and Internet use
• Detail oriented with above average organizational skills
• Plans and prioritizes to meet deadlines
• Excellent customer service skills; communicates clearly and effectively
• Ability to efficiently manage and prioritize time-sensitive tasks that arise

EDUCATION/EXPERIENCE REQUIRED

• High School Diploma or GED
• 2 years medical prior authorization experience preferred
• 2 years experience with MD providers - Orthopedics & Pain preferred.

Job Type:

• Full-time
• Monday to Friday

Benefits:

• 401(k) matching
• Health insurance
• Paid time off
• Paid Holidays

Background Check Requirement: Employment is contingent upon the successful completion of a background check, which may include verification of employment history, education, criminal records, and other relevant information as permitted by law.