Authorization Specialist

Description:

Job Summary:

As an Authorization Specialist you are an employee of the Finance Department and a member of the Billing Team. You will be responsible for verifying insurance coverage and obtaining appropriate insurance authorizations and re-authorizations for appointments and biologics.

This will be a hybrid role with three days required onsite in Sugarloaf and two days remote.

Essential Functions:

• Completes all required authorizations for biologics, surgeries and office visits in a timely manner by contacting insurance companies by phone or online portals.
• Establish and maintain communication with assigned clinics to ensure all authorizations, verification of benefits and reporting are timely.
• Communicate with patients on all medication approvals and denials
• Prepares all necessary paperwork to submit to insurances to obtain approval for prescribed medication and ensure timely delivery for patients
• Ensures all insurance benefits, authorizations and client information are documented efficiently in EMR system and keeps system up to date.
• Contact clients with inactive insurance coverage to obtain and update insurance information.
• Validates coordination of benefits between insurance carriers.
• Provides information to insurance companies to facilitate approval and documents authorization details in patient record.
• Maintains patient record confidentiality in accordance with HIPAA, complying with practice policies and procedures.
• Support the Finance Dept. (which includes the Billing Team) as needed.
• Perform daily office duties.
• Perform all other duties as assigned.

Requirements:

Education, Experience, and Skills:

• Experience with Modernizing Medicine is a plus. EMR experience is required.
• Experience in dermatology is a plus.
• Experience with biologics is a plus.
• Previous experience with managed care, Medicaid and commercial payors highly preferred.
• Excellent verbal and written communication skills.
• Excellent organizational skills and attention to detail.
• Excellent time management skills with proven ability to meet deadlines.
• Possess a strong working knowledge of Microsoft Office.

Physical Requirements:

• Prolonged periods sitting at a desk and working on a computer.
• Must be able to lift a minimum of 15 pounds at times.