Authorization Specialist

Authorization Specialist

Job Summary :

The Authorization Specialist is responsible for performing complex clerical procedures related to verifying insurance information and obtaining authorization for inpatient admissions and specialized clinical procedures and treatments in accordance with established rules, procedures, specified time frames, and regulatory requirements. The Specialist processes clinical information in a timely manner to prevent treatment delays and to avoid denials from third party payers and maintains confidentiality of patient information.

Responsibilities :

• Enters and retrieves information from various automated systems and prepares specialized reports.
• Perform telephonic clinical reviews to Behavioral Health Managed Care Organizations in order to obtain ongoing authorization.
• Ensure completion of Medicare Physician Certification according to regulatory timeline.
• Collects demographic and insurance data and enters accurately into specialized automated systems.
• Prepares, reviews for completion, and maintains required documents in accordance with established procedures, time frames and regulatory requirements.
• Makes contact to obtain missing information for incomplete forms.
• Advises patients and clinical staff of problems with insurance authorizations and resubmits requests with additional or revised information.
• Contacts insurance providers to confirm level of benefits for inpatient admissions.
• Responds to customer inquiries and provides information.
• Serves as liaison between the physician's offices, patients, case management department and Patient Registration.
• Follows up with patients, physicians, clinical and ancillary departments to ensure optimum delivery of services.
• Communicates with case managers, hospital personnel, and external agencies to provide information or resolve discrepancies.

Qualifications / Requirements :

Experience : Two to three years of clerical experience in health care field or related area required, with preference to behavioral health experience.

Education : A high school diploma or equivalency required, Associates Degree Preferred

Licenses / Certifications : N / A

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