Hybrid Authorization Specialist - Healthcare Claims

Mt. Washington Pediatric Hospital; Pine Valley Estates (NC); Hybrid; USD 42,000 - 56,000; Full time

Job summary

EmergeOrtho in North Carolina’s Coastal region is seeking an Authorizations Specialist to join the Ashton office. You will obtain and apply all required authorizations, confirm insurance eligibility, and liaise with physicians, case managers, and carriers to secure timely approvals.

The ideal candidate has strong attention to detail, experience in insurance billing/coding, excellent communication, and proficiency with electronic medical records.

Qualifications

• High school diploma or equivalent.
• Experience in insurance billing and coding is required.
• Minimum two years of patient service experience in healthcare.
• Excellent communication and interpersonal skills.
• Excellent organizational skills and attention to detail.
• Experience using electronic medical records systems (EMR).

Responsibilities

• Obtains orders from the physician.
• Logs all orders in EMR for accurate tracking and scheduling.
• Eligibility, benefits, and authorization are obtained online or via telephone.
• Respond to clinical requests with accurate information; follow up within 3 business days.
• Schedule peer-to-peer reviews with physician and insurer when needed.
• Faxing patient information to outside providers when referred out.
• Follow up on requests within 7–10 days to confirm receipt and appointments.
• Process diagnostic orders within 3–5 days; STAT orders are expedited.
• Obtain surgical authorizations 10 days prior to surgery date unless STAT.
• Maintain electronic log sheet for physical therapy patients with demographics and caps.
• Maintain clinic and patient confidentiality.
• Perform other duties as assigned by Manager.

Skills

Insurance billing

Medical coding

Patient service

Communication skills

Organizational skills

Integrity & confidentiality

Education

High school diploma or equivalent

Tools

EMR systems

Job description

EmergeOrtho in North Carolina’s Coastal region is seeking an Authorizations Specialist to join the Ashton office. You will obtain and apply all required authorizations, confirm insurance eligibility, and liaise with physicians, case managers, and carriers to secure timely approvals.

The ideal candidate has strong attention to detail, experience in insurance billing/coding, excellent communication, and proficiency with electronic medical records.