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.