Insurance Authorization Specialist

$34,320 - $61,776/Yr

Excelsior Orthopaedics - Amherst, NY

Full-time

Amherst, NY

Ambulatory Health Care Services

About the position

The Insurance Authorization Specialist is responsible for obtaining pre-authorizations and pre-certifications for medical services as required by various insurance payers. This role involves ensuring that all authorization information is accurately documented in the system and requires a strong understanding of medical terminology and insurance processes. The specialist serves as a key resource for patients, providers, and coworkers, facilitating communication and education regarding insurance requirements and authorization statuses.

Responsibilities

• Obtain pre-authorizations/pre-certifications per payer requirements for services rendered.
• Ensure authorization information is documented accurately in the system.
• Verify that physician orders are accurate.
• Communicate insurance co-pays, deductibles, co-insurances, and out-of-pocket expenses for point of service collections.
• Maintain communication with providers, clinical staff, and patients regarding authorization status.
• Assist the billing department in researching and resolving rejected, incorrectly paid, and denied claims.
• Maintain a professional atmosphere for patients, family members, and staff.
• Stay current with insurance requirements for pre-authorization and educate departments and clinics on changes.
• Inform management of changes in authorization processes, insurance policies, billing requirements, and denial codes.

Requirements

• High school diploma or equivalent required.
• Knowledge of CPT, HCPCS, and ICD-10 codes highly preferred.
• Medical terminology knowledge required.
• Ability to prioritize and perform multiple tasks with many interruptions.
• EMR experience required; MEDENT preferred.