Job Description

Department Name:

Revenue Cycle Management

Reports to:

Revenue Cycle Supervisor/Manager

GENERAL PURPOSE:

The Authorization Specialist position is responsible for providing obtaining eligibility and authorization functions. This position is also responsible for ensuring accurate data is input into EMR.

ESSENTIAL FUNCTIONS:

•Handles the verification of insurance benefits for patients
•Notifies appropriate teams of deductibles, co-insurances, and out of pockets due
•Initiate Prior Authorization requests to insurance carriers
•Receive request for prior authorizations and ensure they are properly and closely monitored
•Accurately enter required information into the EMR
•Follow up on authorization requests in a timely manner
•Regularly calls insurance companies to follow up on requests
•Attach incoming insurance information into EMR and follow established procedures for distributing information for further review by intake team
•Inform appropriate team(s) of approaching re-auth dates or expiring insurance policies
•Escalates issues to Supervisor
•Establish effective rapport with other employees within the department as well as with the clinical intake team and staff
•Recognize trends identifying issues with payer authorizations
•Provides guidance related to questions about the eligibility and authorization
•Additional duties as assigned by Supervisor

QUALIFICATIONS

•High School Education or GED
•1+ years of insurance verification preferred
•Medical Office Background preferred
•Home Health or Hospice knowledge preferred
•Experience with payer provider portals preferred
•Computer proficiency – MS Office and web enabled applications strongly preferred
•Excel knowledge
•Customer Service experience preferred

ADDITIONAL REQUIREMENTS:

•Willingness to learn
•Self-motivation and the ability to work independently as well as in a team
•Provide quality customer services to internal and external teams
•Must be able to work productively in an environment with high levels of interruption; work efficiently and effectively meeting multiple deadlines and changing priorities with strong attention to detail
•Exceptional organization skills
•Maintain patient confidentiality as defined by state, federal, and company regulations
•Ability to effectively communicate with all levels of management
•Strong work ethic: results focus with a strong desire to achieve goals
•Ability to use a computer keyboard and mouse 6-8 hours a day
•Occasionally lift/carry items weighing up to 25 lbs.
•Ability to dial, answer and talk on a telephone for multiple hours a day
•Ability to handle completing a task in high levels of interruption while paying close attention to detail
•Ability to maintain confidentiality
•Ability to effectively communicate with all levels of management
•Team player