Insurance Authorization Specialist

Excelsior Orthopaedics - Amherst, NY

Full-time

Amherst, NY

Ambulatory Health Care Services

About the position

The Insurance Authorization Specialist at Excelsior Orthopaedics Group is responsible for obtaining pre-authorizations and pre-certifications for services rendered, ensuring that all authorization information is accurately documented in the appropriate systems. This role requires a strong understanding of insurance carriers, medical codes, and terminology, making the specialist a vital resource for patients, providers, and coworkers.

Responsibilities

• Obtains pre-authorizations/pre-certification per payer requirements for services rendered and ensures authorization information is documented in the appropriate system.
• Verifies physician orders are accurate.
• Communicates insurance co-pays, deductibles, co-insurances, and out-of-pocket expenses for point of service collections.
• Maintains communication with providers, clinical staff, and patients regarding authorization status.
• Assists the billing department in researching and resolving rejected, incorrectly paid, and denied claims as requested.
• Helps maintain a professional atmosphere for patients, family members, and staff.
• Stays current with insurance requirements for pre-authorization and provides education within the departments and clinics on changes.
• Keeps management informed of changes in authorization processes, insurance policies, billing requirements, and rejection or denial codes as they pertain to claim processing and coding.

Requirements

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