Authorization Specialist (Remote) id-1142
Company Overview: Our organization is committed to enhancing the healthcare journey for our members. We are dedicated to delivering accessible, high-quality care tailored to the unique needs of our communities. As a Referral / Authorization Specialist, you will play a crucial role in ensuring our members promptly receive the services they require.
Summary: We are seeking a highly organized and detail-oriented individual to join our team. The ideal candidate will possess extensive knowledge of prior authorization and referrals processes, medical terminology, and ICD-10 coding. The primary responsibilities include processing faxes, building authorizations, and effectively communicating with healthcare providers. This role requires a strong understanding of medical billing codes, computer literacy, and the ability to ensure compliance with State and Federal healthcare regulations.
Essential Functions
- Provide accurate and efficient computer entries for authorization requests and provider inquiries through phone, mail, or fax.
- Verify member eligibility and benefits to facilitate appropriate authorization procedures.
- Determine provider contracting status and ensure appropriateness for the requested services.
- Assess diagnosis and treatment requests, assigning appropriate billing codes (ICD-10 and/or CPT/HCPC codes).
- Verify coordination of benefits (COB) status for members.
- Verify and maintain inpatient hospital census, including admissions and discharges.
- Coordinate with healthcare providers to ensure timely and accurate information exchange.
- Communicate with healthcare providers, both verbally and in writing, to gather necessary information and address inquiries.
- Triage members and information to the appropriate Health Care Services staff, ensuring seamless workflow.
- Enter relevant data into systems accurately and promptly.
- Maintain up-to-date and comprehensive records of authorizations and related information.
- Check eligibility for members requiring hospitalization or utilization review for other healthcare services.
- Verify and communicate benefits information to relevant stakeholders.
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Qualifications
- Proficiency in medical terminology, ICD-10 coding, and prior authorization processes.
- Strong computer literacy and experience with healthcare databases.
- Excellent organizational and multitasking skills.
- Effective communication skills, both written and verbal.
- Detail-oriented with a commitment to accuracy.
- Ability to work collaboratively in a team-oriented environment.
Education And Experience
- High school diploma or equivalent; Bachelor's degree in a related field is a plus.
- 1+ year of experience in referral and authorization coordination within the healthcare or managed care sector.
- Familiarity with State and Federal healthcare regulations.
