Database specialist [h1.location_city]

POSITION

Authorization Specialist

REPORTS TO

Billing Manager

JOB DESCRIPTION

Summary

Responsible for all aspects of the prior authorization process. Responsibilities include collecting all necessary documentation, communicating with providers for additional information and completion of the required prior authorization in order to proceed with procedure. Complete, timely and accurate identification and submission of authorization requests to the payers, including but not limited to prior authorizations, retro authorizations, and single case agreements.

Essential Functions

• Responsible for the verification of insurance information, as well as documenting the need for authorization or lack of need for authorization in CPSI to facilitate claims processing.
• Contacts insurance carriers to secure authorization information. Documents authorization information in CPSI to ensure admissions are approved.
• Acts as a resource for the department personnel as it relates to the authorization process and documentation required for services.
• Assures that authorizations are obtained prior to date of service and communicates with scheduling / billing manager regarding status of authorizations.
• Relays authorization approval, peer to peer request or denial status to the Billing / Scheduling Manager and physician's office.
• Scans authorization confirmation / denials to physician's office.
• Submit retro-authorization to the payers within 48 hours of patient procedure.
• Assists the billing manager, billers, schedulers, receptionist and / or medical records coordinator.
• Performs other duties as assigned.

Physical Demands

While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.

Required Education and Experience

Required Skills and Certifications

EEO Statement

Our corporation is committed to equal employment opportunity. We do not discriminate against employees or applicants for employment on any legally-recognized basis ("protected class") including, but not limited to : race, color, religion, national origin, sex, pregnancy (including childbirth and related medical conditions), age, disability, citizenship status, status as a current or former uniformed servicemember, genetic information, or any other protected class under federal, state, or local law.