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Insurance Authorization Specialist
Excelsior Orthopaedics - Buffalo, NY
posted about 2 months ago
About the position
The Insurance Authorization Specialist at Excelsior Orthopaedics is responsible for obtaining pre-authorizations and pre-certifications for medical services as per payer requirements. This role is crucial in ensuring that authorization information is accurately documented and communicated to patients, providers, and clinical staff. The specialist will leverage their knowledge of insurance carriers and medical coding to assist in the billing process and maintain compliance with insurance policies.
Responsibilities
- Obtain pre-authorizations/pre-certification per payer requirements for services rendered.
- Ensure authorization information is documented accurately in the system.
- Verify physician orders for accuracy.
- 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 on changes.
- Inform management of changes in authorization processes, insurance policies, and billing requirements.
Requirements
- High school diploma or GED required.
- Knowledge of CPT, HCPCS, and ICD-10 codes highly preferred.
- Medical terminology knowledge required.
- Ability to prioritize and perform multiple tasks with interruptions.
- EMR experience required; MEDENT preferred.
