Healthcare Authorization Specialist – Medical Necessity & Billing

Lehigh Valley Hospital; Pottstown (Montgomery County); On-site; USD 42,000 - 54,000; Full time

Job summary

Lehigh Valley Health Network seeks an Insurance Authorization Specialist to obtain approvals for surgical procedures, tests, medications and referrals. You will verify benefits, determine financial responsibility, and communicate with providers and payers to ensure timely payments.

Responsibilities include reviewing medical necessity, following policy guidelines, and maintaining HIPAA compliance in a fast-paced, patient-centered environment. Day shift, onsite in Montgomery County.

Qualifications

• High School Diploma/GED with specialized training in insurance, coding, billing, or similar healthcare certificate programs.
• 1 year in a healthcare setting with insurance verification/authorizations.
• Familiarity with billing procedures and payer reimbursement.
• Knowledge of patient rights and laws relative to those rights, such as HIPAA.
• Proficient in utilization management processes, standards, and managed care.
• Proficient in standard medical practices and insurance benefit structures.

Responsibilities

• Collaborates with physicians and provider office staff in ascertaining the appropriate authorization based on medical necessity and the treatment plan provided.
• Performs a medical necessity check to determine if procedure and diagnosis support medical necessity.
• Ensures authorizations are obtained in accordance to network policy (any authorization not falling into policy guidelines is communicated to ordering office, patient, and manager).
• Communicates direct/indirect with insurance companies to obtain insurance verification, benefits and precertification for approval.
• Verifies additional clinical information and insurance authorizations/referrals.
• Reviews and monitors WQs/schedules to ensure that proper and accurate authorization has been received prior to patient's visit.
• Maintains compliance with benchmark data regarding accounts registered versus scheduled procedures.
• Determines estimated patient financial responsibility using insurance verification information and payer contracts and/or self-pay guidelines.

Skills

Billing procedures

Payer reimbursement

HIPAA compliance

Utilization management

Medical billing practices

Education

High School Diploma/GED with specialized training in insurance, coding, billing, or similar healthcare certificate programs

Associate's Degree

Job description

Lehigh Valley Health Network seeks an Insurance Authorization Specialist to obtain approvals for surgical procedures, tests, medications and referrals. You will verify benefits, determine financial responsibility, and communicate with providers and payers to ensure timely payments.

Responsibilities include reviewing medical necessity, following policy guidelines, and maintaining HIPAA compliance in a fast-paced, patient-centered environment. Day shift, onsite in Montgomery County.