Insurance Authorization Specialist

OrthoIndy Northwest; Indianapolis (IN); On-site; USD 45,000 - 60,000; Full time

Job summary

OrthoIndy is seeking an Insurance Authorization Specialist to verify insurance coverage and obtain preauthorizations for procedures, including surgical and pain management cases. The role inputs accurate data into multiple systems and navigates complex online portals to ensure timely authorization.

You will serve as a liaison to physicians and staff, monitor authorizations, address denials, and support revenue cycle with audits and ongoing communications. Equal opportunity employer.

Qualifications

• Requires knowledge of ICD-10, CPT, and medical terminology.
• Experience with insurance authorization and precertification processes.
• Ability to navigate multiple electronic health record and practice management systems.
• Strong communication with physicians, staff, and patients.

Responsibilities

• Verifies active insurance status and documents precertifications.
• Submits information for precertification/authorization.
• Monitors authorizations to minimize denials and updates records.
• Notifies departments of coverage issues and obtains corrected info as needed.
• Performs audits and updates for revenue cycle related to denials monthly.

Skills

ICD-10 knowledge

CPT terminology

Medical terminology

Insurance guidelines

Education

High School Diploma/GED

Bachelor's degree preferred

Specialty medical office training

Job description

Great people are the backbone to great care and patient satisfaction. In return, we’ll have your back—offering our employees a supportive team environment, great benefits, a true work/life balance, and the opportunity to positively impact the quality of life for our patients. Join TEAM OI.

General Statement of Duties:

The Insurance Authorization Specialist verifies insurance coverage and obtains insurance authorization prior to procedures, including; surgical and interventional pain management procedures. The Specialist is responsible for providing accurate and complete data input into multiple electronic systems for precertification requests, and for maintaining multiple online accounts to ensure immediate access. The position navigates complex online and telephonic insurance systems in a timely manner and manages frequent interruptions and prioritizes work in a dynamic fast paced work environment. The Specialist notifies the appropriate departments if insurance coverage is incorrect and obtains and inputs corrected insurance information as needed and follows established policies and procedures in order to manage various insurance denial situations.

• Verifies active insurance status and network information for each patient. Submits required information to insurance companies for precertification and authorization. Monitors authorizations to minimize last-minute insurance denials. Proactively acts to provide additional clinical information to insurance ensure companies receive all available documentation as needed. Confirms receipt of all necessary preauthorization documents before procedures. Annotates steps completed on surgery orders and downloads authorization documentation into the practice management program for future reference. Utilizes practice management tools to indicate admit status (inpatient or outpatient), the number of days approved, CPT codes approved, effective date, expiration date, and all authorization numbers to ensure accurate flow of information from authorization department to hospital admissions and case management. Takes necessary steps to correct or cancel procedure if preauthorization information is missing or incorrect. Communicates next steps to appropriate teams if additional action is needed outside the authorization department.
  
• Provides insurance authorization audits and updates for the revenue cycle team related to insurance denials each month.
  
• Serves as a point of contact for assigned Physicians and employees. Maintains rapport with Physicians, private staff, and coworkers to ensure excellent communication and satisfaction. Handles phone calls, tasking, and messages in the electronic medical record related to the scheduled medical procedure's insurance authorization process.
  
• Provides updated clinical documentation from ordering provider or preadmissions testing if additional medical necessity documentation is required to obtain authorization.
  
• Pre-operatively notifies ordering surgeon's team if insurance authorization does not include all CPT codes submitted or if insurance denies ordered admit status. Takes appropriate steps to verify ordering surgeon received notification. Also, confirms admit status and insurance authorization match in EHR and practice management systems.
  
• Develops and supports effective communication with other employees, professional support staff, customers, patients, families, and providers to ensure patient satisfaction.
  
• Support departmental and corporate strategic plans and ensure successful implementation.
  
• Support company and department quality assurance initiatives and goals.

Requirements:

• High School Diploma/GED required; Bachelor's degree preferred
• Specialty training beyond high schoolrequired; I.e. Medical office certification and/or some college
• Knowledge and experience related to ICD-10, CPT, medical terminology, or insurance clinical guideline requirements required
• 4-6 yearsof related experience required; 6-8 years preferred

OrthoIndy is an Equal Opportunity Employer