Healthcare Authorization & Insurance Specialist

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

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