Billing Authorization Specialist

Position Description

Department

Patient Services

Reports To

Billing Office Supervisor

FLSA Status

Non-Exempt

Pay Range

Hourly

EEO Category

5 – Administrative Support Worker

Position Summary

The Billing Authorization Specialist is responsible for managing daily authorization and referral submissions for the organization. This role requires strong attention to detail in maintaining accurate records, proficiency in medical terminology and a solid understanding of Explanation of Benefits (EOBs) and insurance plan types. Effective communication skills are essential, along with the ability to verify patient benefits, problem-solving capabilities and the capacity to meet deadlines while maintaining workflow efficiency and adaptability. The Billing Authorization Specialist plays a critical role in securing authorizations and referrals for services, providing explanations of benefits as needed, collecting payments and performing other essential duties that support the Patient Services and Billing Office.

Working Conditions

General office and sedentary, requiring extended periods of time at a keyboard or workstation. Ability to exert a light degree of physical effort including carrying, pushing, pulling, climbing, balancing, standing, stooping, kneeling, crouching, crawling, walking and the assisted lifting of objects and materials up to 25 pounds. Specific vision abilities include close vision and distance vision. Limited exposure to adverse environmental conditions, such as dirt, dust, odors, humidity, temperature and noise extremes, wetness and vibrations. Use of personal computing equipment, telephone, multi-functioning printer and calculator. Manual dexterity, ability to reach, bend, and use 2-step stool while safely lifting and lowering boxes. Ability to travel to and from meetings, training sessions or other business-related events. May be required to work after hours to include weekends and holidays.

Essential Functions

Verifies insurance benefits and coverage for patients, ensuring all required documentation is in place.

Communicates with patients regarding their insurance coverage, co-pays, and out-of-pocket costs.

Prepares and maintains reports in compliance with state and federal regulations.

Monitors status of authorization request in accordance with internal protocols and initiate follow up as necessary to ensure receipt of established authorization within established timelines.

Secures needed medical documentation required or requested by third party insurance carriers.

Contacts insurance companies, or utilize web-based insurance resources, to obtain verifications and authorizations for medical procedures.

Obtains, reviews and inputs insurance authorizations and physician referrals prior to patient services.

Reviews denied claims and works with insurance companies to resolve authorization-related issues.

Collaborates with therapists, physicians, and case managers to ensure scheduling needs are met based on authorizations received as approved.

Keeps updated on all billing and benefit changes for third party insurance carriers.

Monitors and audits claims for missing information that will cause delays in claims processing.

Verifies and updates patient and family demographic information in the EHR system (Electronic Health Record System), including scanning, filing, purging, and obtaining any missing required documents.

Supports administrative functions by answering and returning calls, scheduling appointments, contacting families and following up on inquiries.

Occasionally interacts with children, their families and specialized mobility devices.

Serves and protects CRIT-USA’s community by adhering to professional standards, policies and procedures, federal, state and local requirements.

Ensures the protection of confidential information in accordance with HIPAA guidelines as well as organization policies.

Stays updated on insurance policies, industry regulations, and billing guidelines for rehabilitation services.

Must be energetic, collaborative, receptive to guidance and eager to learn through cross-training.

Performs other duties, tasks and special projects as assigned.

Knowledge, Skills & Abilities

Education

Experience

License & Certification

Testing

Other

• High School Diploma or GE certificate

• Minimum 1 year of experience in medical billing, insurance verification or prior authorization preferred

• Certified Medical Billing and Coding Specialist (CMBS, CPC, or equivalent) is a plus.

• Valid Texas Driver License

• Criminal background check

• Non DOT drug test

• Strong Knowledge of medical terminology, coding and HIPAA regulations

• MS Office Programs

• EHR/EMR Systems

• Bilingual in Spanish

Special Notes

• Very important to this position are: active listening, mathematics, financial management, ethical conduct, accuracy, speaking, reading comprehension, writing, critical thinking, speaking, judgment and decision making.

• Important to this position are: complex problem solving, time management, flexibility, detail oriented and active learning.