Overview
The Authorization Specialist will be responsible for financially securing scheduled surgical procedures undertaken by the Vascular Care Group by verifying insurance eligibility and coverage of incoming patients.
Responsibilities
- Monitoring upcoming surgical cases, procedures and imaging on the physician's calendars
- Responsible for identification and authorization of all codes that may be used throughout complex and variable patient treatments
- Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms necessary information to allow processing of claims to insurance plans
- Collaborates with other departments to ensure documentation is received prior to services
- Assists with medical necessity documentation to expedite approvals and ensure the appropriate follow-up
- Obtains, distributes, and documents referral authorization numbers
- Helps monitor cancellations, expirations, and changes to authorizations and referrals
- Documents authorizations and progress of authorizations in the patient's chart
- Ensures all updates to documentation in client's file are completed in a timely manner
- Assists with the resolution of authorization related denials and billing holds
- Participates in providing ongoing training and education of staff as it relates to new processes to ensure timely confirmation of surgical cases
- Ensures compliance with appropriate industry regulations and State and Federal regulations
- Safeguard strict confidentiality of all health records, member information and meet HIPAA guidelines
- Assists with medical record requests, front desk tasks, and patient collections as needed
- Performs other duties as assigned
Requirements
- Bachelor's degree preferred
- 1+ years of surgical insurance verification experience required
- Vascular experience preferred
- Working knowledge of eligibility, verification of benefits, and prior authorizations from various HMOs, PPOs, commercial payers and other funding sources
- Proficiency in establishing good working relationships with both internal and external vendors/customers, both in person and over the phone
- Outstanding written and verbal communication skills, with close attention to detail
- Demonstrated ability to analyze data and work independently within a fast-paced work environment
- Proficiency in technology, in particular Microsoft Office Suite
- Excellent organizational and prioritization skills