INSURANCE AUTHORIZATION SPECIALIST

4 weeks ago
By Diane Boswell
Posted: Updated:
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Position: INSURANCE AUTHORIZATION SPECIALIST


Department: BUSINESS SERVICES


JOB SUMMARY

Monitors incoming patient orders and gathers information needed to complete the pre-authorization and scheduling of an order.
Evaluates portions to be paid by the customer as well as performs all insurance related assignments as instructed.


JOB RELATIONSHIPS

Responsible to: Director of Business Services

Employees Supervised: None

Interrelationships: Employees, Case Management, Patients, Directors


JOB RESPONSIBILITIES

Completes authorization and referrals for services, including appointments and procedures.

Checks insurance eligibility for patients.

Contacts referring physicians for additional information as needed.

Inputs new patient information and updates information in system.

Monitors schedule for potential issues.

Assists with other clerical tasks as needed.

Initiates appeals for denied authorizations.

Responsible for all prior authorizations being received prior to services being performed.

Once prior authorization is received then the services can be scheduled.


KNOWLEDGE, SKILLS, AND ABILITIES

Knowledge of procedure authorization and direct impact on the practice’s revenue cycle.

Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively.

Basic understanding of human anatomy, specifically musculoskeletal.

Proficient use of CPT and ICD-10 codes.

Excellent computer skills including Excel, Word, and internet use.

Detail oriented with above average organizational skills.

Plans and prioritizes to meet deadlines.

Excellent customer service skills; communicates clearly and effectively.

Ability to multitask and remain focused while managing a high-volume, time-sensitive workload.

Knowledgeable on the prior authorization requirements from each payer and the systems associated.


QUALIFICATIONS

EDUCATION:
High school diploma or equivalent required.

TRAINING AND EXPERIENCE:
Insurance authorization experience is required.

JOB KNOWLEDGE:
Strong understanding of insurances and authorization protocols.


WORKING CONDITIONS AND PHYSICAL DEMANDS

Exhibits actions that support Salem Township Hospital’s mission daily as evidenced by attitude, participation in and support of departmental and organizational initiatives.

Must be able to effectively communicate with a wide variety of contacts at all levels of the organization.

While performing the duties of this job, the employee is frequently required to sit, talk, or hear; and use hands to handle, touch objects or controls.

The employee is regularly required to stand and walk. On occasion, the employee may be required to stoop, bend, or reach above the shoulders.

Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability adjust focus.

Must be able to work overtime when scheduled or required.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


COMPETENCY

Business Services staff maintains their competence through ongoing assessment and equipment competency that is job specific.

The competency criteria are based on procedures that have been identified as problem prone, high risk, low volume.

It is the responsibility of the Business Services staff to complete the designated competency.

Competency may be demonstrated by the following means:

1. direct observation
2. demonstration
3. patient interview
4. tests
5. outside sources


Hours Per Schedule

Full Time
Mon-Fri
8:30am-5:00pm

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Applications are also available at the hospital, or resumes may be mailed to:

Salem Township Hospital
1201 Ricker Drive
Salem, IL 62881
Attn: Human Resources

618-548-3194, ext. 8187

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