Authorization Specialist, Workers Compensation

$45,760 - $49,920/Yr

Metro Physical & Aquatic Therapy - Garden City, NY

Full-time - Entry Level

Garden City, NY

Ambulatory Health Care Services

About the position

The Authorization Specialist for Workers Compensation at Metro Physical & Aquatic Therapy is responsible for managing the prior authorization process for patients. This role involves collecting necessary documentation, ensuring timely submission of authorization requests, and maintaining communication with clients and providers. The specialist will work collaboratively within a multidisciplinary team to ensure compliance with healthcare regulations and provide excellent customer service.

Responsibilities

• Collect all necessary documentation for prior authorization.
• Contact clients for additional information and completion of required prior authorization.
• Complete timely and accurate identification and submission of prior and retro authorization requests.
• Ensure all pre-authorizations have been approved with the proper procedure code prior to service being rendered.
• Ensure that ICD10 diagnosis codes are entered correctly by all Therapists.
• Input authorizations and update miscellaneous screens to ensure authorizations are processed.
• Provide data entry for proper level of care arranged by the Authorization received from funding sources.
• Contact providers and patients with authorization, denial, and appeals process information.
• Responsible for pending claims reports on claims received without prior authorization.
• Generate appropriate referrals with notification and exchange of information for proper adjudication of claim payment.
• Maintain robust documentation of authorization processes and procedures.
• Assist patients, site staff, and management with authorization issues.
• Collaborate with other departments to receive and process authorization forms.
• Document processes and procedures as well as conversations with clients and insurance carriers.
• Generate expected collections report to notify patients of cost responsibilities.
• Make corrections on patient accounts when errors are identified.
• Maintain referred physician National Provider Identifier (NPI).
• Maintain strict confidentiality and adhere to HIPAA guidelines/regulations.

Requirements

• Minimum 2 years of experience in the healthcare field in a similar function.
• Experience required in no fault & workers compensation.
• Knowledgeable in MG 2's and C4 authorization.
• Experience submitting authorization requests for W/C.
• Experience working closely with Dr. Offices and Adjusters.
• Strong customer service skills; ability to diffuse client frustrations.
• Current or recent experience in a medical practice ensuring compliance with federal, state, and local regulations and guidelines.
• Proficiency in Word, Excel, and Google Suite.
• Ability to use logic and problem-solving skills to resolve issues and navigate between dual monitors.
• Ability to work independently under tight deadlines in a rapidly changing environment.
• Ability to handle stressful situations resulting from high volume of phone calls, technical problems, and frustrated customers.
• Excellent interpersonal and communication skills.
• High school diploma or GED is required.

Benefits

• 401(k) Retirement Savings
• Health Insurance
• Dental Insurance
• Vision Insurance
• Free Life Insurance
• Vacation & Paid Time Off
• Flexible Spending
• NY 529 College Savings Program
• Identity Theft Insurance