Healthcare Authorization Specialist

Summit Health Management; Berkeley Heights (NJ); On-site; USD 52,000 - 65,000; Full time

Job summary

VillageMD is seeking an Authorization Specialist to obtain authorizations for surgical procedures, diagnostic testing, medications, DME, and referrals as part of the Revenue Cycle Department. You will verify insurance eligibility, navigate carrier guidelines and state policies, communicate with patients and providers, and help reduce denials while upholding patient confidentiality.

The role requires a high school diploma, familiarity with Microsoft Office, and experience with Epic; we offer a

Qualifications

• High School Graduate/GED Required.
• 2-4 years of related experience preferred.
• Experience with Microsoft Office Suite Required.
• Experience Standard Office Technology in a Window based environment & Microsoft Office Suite Required.

Responsibilities

• Identifies all appointments and procedures for assigned departments that require authorization by monitoring schedules, system reports and dashboards.
• Verifies insurance eligibility and benefits, and updates the patient’s insurance information as necessary.
• Completes referrals and prior authorizations in a timely manner according to department guidelines and workflows.
• Communicates clearly and effectively with patients, physicians, office staff and manager to resolve issues that may result in a denied or delayed authorization request.
• Demonstrates the ability to use electronic tools and systems to organize and process daily work.
• Collaborates with Reimbursement Department teams to limit denials and ensure proper reimbursement.
• Maintains patient confidentiality.

Skills

Communication

Insurance knowledge

Team collaboration

Education

High School/GED

Vocational/Technical training

2-4 years experience

Tools

Epic

Microsoft Office

Job description

VillageMD is seeking an Authorization Specialist to obtain authorizations for surgical procedures, diagnostic testing, medications, DME, and referrals as part of the Revenue Cycle Department. You will verify insurance eligibility, navigate carrier guidelines and state policies, communicate with patients and providers, and help reduce denials while upholding patient confidentiality.

The role requires a high school diploma, familiarity with Microsoft Office, and experience with Epic; we offer a