Authorization Specialist

AUTHORIZATION SPECIALIST

Our highly professional Authorization Specialist is responsible for pre-certification and pre-authorization for procedures treatment(s) and testing. The Authorization Specialist has a high proficiency for communicating internally as well as with patients and their families regarding the needs/status of prior authorization. This position reports to the Practice Administrator.

PRIMARY RESPONSIBILITIES

Works directly with the insurance companies Chicago ENT staff/providers and external referring staff/providers to ensure an efficient authorization process.

Daily monitors schedules and orders to begin prior authorization.

Accurately verifies patient insurance/benefits before beginning prior authorization.

Communicates plan limitations or non-covered services with ordering physician and patient.

Monitors prior authorization from initiation to completion:

o Submits all ordered CPT and ICD-10 diagnosis codes.

o Submit necessary clinical information coordinate peer-to-peer calls and appeals denied authorizations.

o Once approved alerts the patients and providers and documents status on EMR appointment.

o Records prior authorization/reference numbers in the EMR for billing department.

Answer screen respond and rout phone queries in addition to checking voicemails telephone encounters faxes and other inbound communication.

Cooperate and maintain good rapport with admin staff medical staff other departments and visitors.

Review denied claims and proactively work with billing to identify processing issues and errors.

Act as an expert to answer questions from patients and staff.

Maintain a professional approach with confidentiality regarding all patient information.

Performs other selected administrative duties as directed by physicians or Practice Administrator.

REQUIRED QUALIFICATIONS

Two years of medical insurance verification and authorization experience.

Excellent organizational skills and attention to detail.

Excellent verbal and written communication and interpersonal skills.

Excellent time management skills.

Strong analytical and problem-solving skills.

Must have the ability to remain calm in stressful situations to be flexible to work well with many interruptions and to be able to multi-task.

Must exhibit and promote a high level of customer service hospitality curiosity and friendliness towards all patients employees and the overall facility.

Bilingual preferred.

Proficiency in completing pre-authorizations via insurance web sites.

SUPERVISORY RESPONSIBILITY

This position has no supervisory responsibility.

CERTIFICATES LICENSES REGISTRATIONS

None required.

ENT is a drug-free environment and an Equal Opportunity Employer. We offer competitive salaries and benefits including medical/dental life and disability coverage generous vision benefits a 401 (k) plan with a match vacation time and weekends and major holidays off.

Required Experience:

IC