Authorization Specialist

Bon Secours

Full-time

101-250 employees

Nursing and Residential Care Facilities

About the position

The Authorization Specialist is responsible for performing complex clerical procedures related to verifying insurance information and obtaining authorization for hospital procedures and tests, as well as office diagnostic testing. This role ensures compliance with established rules, procedures, and regulatory requirements while maintaining patient confidentiality. The specialist processes clinical information efficiently to prevent treatment delays and avoid denials from third-party payers.

Responsibilities

• Serves as liaison between physicians, office staff, patients, and insurance carriers regarding the authorization process.
• Collects and reviews for accuracy patient demographic and insurance data as part of the authorization process.
• Collects and submits all documentation and diagnosis needed for Authorizations.
• Advises physicians, Oncology RNs, Billing manager, and practice Administrator of problems with insurance authorizations and resubmits requests with additional or revised information as needed.
• Notifies provider of the need for peer-to-peer reviews for problem cases which have been initially denied authorization for services and assists with the arrangement of same.
• Provides daily follow-up with the authorization departments of various insurance carriers for updates on the status of authorization requests.
• Adheres to policy to prevent denials or patient delays.
• Performs eligibility checks on insurance payer's internet websites and RTE.
• Effectively utilizes automated systems to perform work assignments.
• Continually reviews diagnostic testing schedules at multiple locations to capture any changes, such as add-on testing.
• Reviews daily what authorizations for procedures have processed and what is outstanding.
• Logs in deliveries of medications received from Specialty pharmacies daily and notifies the appropriate person via EMR and in person.
• Performs other tasks as assigned.

Requirements

• 1-3 years of experience in the health care field is required.
• Previous experience with the pre-authorization process is required.
• Experience in the field of oncology is preferred.
• A high school diploma or equivalency is required.

Benefits

• Health Insurance
• Dental
• Vision
• Retirement Savings Plan
• Flexible Savings Account
• Paid Time Off
• Holidays
• Tuition Reimbursement