Outpatient Authorization Specialist-Fast, Accurate Preauth

Westchester Medical Center Health Network; City of Port Jervis (NY); Vor Ort; USD 42.000 - 56.000; Vollzeit

Zusammenfassung

Westchester Medical Center Health Network is seeking an Authorization Specialist to secure payment for outpatient services and verify insurance benefits. The role acts as a liaison among physicians, the OR, and registration to ensure a smooth patient flow and accurate consent and documentation in Cerner.

Responsibilities include validating orders and medical necessity, performing registrations, and resolving denials through thorough chart review while maintaining high customer service standards.

Qualifikationen

• Knowledge of insurance requirements, plans, pre-certification requirements and contract benefits.
• ICD 10 and CPT codes.
• Medical terminology.
• 3-5 years of experience in a pre–authorization specialty preferred.
• Ability to assess and solve customer problems using excellent interpersonal, oral and written communication.

Aufgaben

• Utilize multiple patient information systems to obtain and secure authorization, verify benefits and perform medical necessity checks.
• Obtain, validate and interpret clinical documentation including orders, H&P, progress notes; review lab and radiology results; ensure guidelines are met.
• Perform registration functions.
• Assist in resolution of denials and billing issues through extensive chart review including retro authorizations, codes and documentation.
• Maintain and resolve assigned Account and Patient work queues; adjust accounts and insurances as necessary.

Jobbeschreibung

Westchester Medical Center Health Network is seeking an Authorization Specialist to secure payment for outpatient services and verify insurance benefits. The role acts as a liaison among physicians, the OR, and registration to ensure a smooth patient flow and accurate consent and documentation in Cerner.

Responsibilities include validating orders and medical necessity, performing registrations, and resolving denials through thorough chart review while maintaining high customer service standards.