Authorization Specialist

Description:

Pulmonary Medicine Associates (PMA) has been treating patients in the greater Sacramento area for over 50 years and is a unique and exciting place to work. With specialties that include Critical Care, Infectious Disease, Palliative Care, Pulmonology, Pediatric Pulmonology, and Sleep Medicine, we are a busy practice with over 80 providers and 2 outpatient clinic locations.

PMA currently has a position open for an Authorization Specialist position at our Roseville clinic. PMA offers a competitive salary and exceptional benefits including medical, dental, vision, life, LTD, PTO, and 401k with generous company match. Please visit our website at www.pmamed.com to learn more. PMA is an equal opportunity employer.

• Schedule pulmonary procedures, diagnostic testing, and follow-up appointments according to physician orders and clinical protocols.
• Obtain and track insurance authorizations and referrals for procedures, diagnostic testing, and specialty services.
• Verify insurance benefits, eligibility, and authorization requirements.
• Submit authorization requests to insurance companies and follow up to ensure timely approval.
• Monitor authorization status and maintain accurate documentation in the electronic medical record (EMR).
• Coordinate procedures with hospitals, ambulatory surgery centers, imaging facilities, pulmonary function laboratories, and other outside facilities as needed.
• Communicate with patients regarding procedure dates, preparation instructions, required referrals, insurance requirements, and pre-procedure appointments.
• Ensure required clinical documentation, orders, test results, and medical records are available prior to scheduled procedures.
• Identify authorization or scheduling issues that may delay patient care and escalate them appropriately.
• Reschedule procedures when necessary and communicate changes promptly to patients, providers, and facility staff.
• Work closely with providers, nurses, medical assistants, referral coordinators, and front-office staff to facilitate efficient patient care.
• Maintain accurate scheduling and authorization records while protecting patient confidentiality.
• Follow payer requirements, practice policies, and applicable healthcare regulations.
• Perform other front office tasks as assigned.

Requirements:

• High school diploma or GED
• Minimum of two years related work experience in a medical environment preferred.
• Knowledge of medical terminology.
• Knowledge of medical billing procedures and HMO/PPO insurance programs.
• Excellent phone etiquette and verbal communication skills.
• Strong customer service skills and ability to establish and maintain effective working relationships with other employees, patients and the general public.
• Strong detail orientation.
• Ability to maintain confidentiality of sensitive information.
• Ability to work independently and juggle multiple priorities.
• Ability to communicate clearly and effectively in person and on the telephone to establish and maintain cooperative relationships with patients, families, physicians, staff, and other customers.
• Must be able to accurately type 45 WPM.
• Valid California driver’s license and automobile insurance. Ability to drive to different clinics and run occasional errands.

Physical Requirements/Working Conditions:

• Must be able to work in a climate controlled, office environment.
• Sit for extended periods of time.
• Ability to read and write in order to process paperwork.
• Manual dexterity needed for keyboarding and other repetitive office tasks.
• Vision must be good or corrected to normal to perform normal job duties.
• Hearing must be good to have the ability to understand information to perform job duties.