Authorization Specialist

The Authorization Specialist is responsible for providing a great patient experience by checking patient eligibility and initiating prior authorizations. Includes utilizing online resources, reviewing medical records, calling insurance companies, and completing authorization forms in our Electronic Medical Record system.

ESSENTIAL RESPONSIBILITIES:

• Check patient eligibility and insurance plan benefits via online payer portals and confirming with insurance companies

• Scan complete authorization form in EMR system

• Review medical records

• Initiate authorizations using online resources, insurance specific forms, and making outgoing calls to insurance companies

• Follow department procedures to ensure timely completion of benefit investigations

• Communicate with internal patient financial services department, clinical staff and external practice managers when inaccurate demographic information is supplied

• Review and update authorization information in the EMR system

• Support and actively participate in initiatives designed to improve individual and organizational performance.

• Coordinate with clinical staff to set up peer to peer meetings for physicians and insurance medical directors.

• Assist patients with insurance denials and appeals

• Performs other duties/special projects and tasks as assigned

KNOWLEDGE AND SKILLS:

• Able to read, interpret, and implement specified records.

• Knowlege of Medical and Diagnosis codes (CPT/DX)

• Demonstrated knowledge of medical terminology and office procedures.

• Demonstrated knowledge of third-party and insurance company operating procedures, regulations and billing requirements.

• Experience with Microsoft Office suite and Electronic Medical Record (EMR) system.

• Ability to effectively establish and maintain cooperative and effective working relationships

• Effectively prioritize competing responsibilities, with a sensitivity toward matters which are time sensitive.

• Exercise a high level of discretion and sensitivity to patient privacy.

• Ability to recognize, evaluate, solve problems and correct errors.

• Ability to use telephone, keyboard, computer, office equipment and software programs.

EDUCATION AND/OR EXPERIENCE:

• High School diploma or equivalent required
• 1-3 years' work experience in a healthcare environment required

Inception offers fantastic benefits to our team (Family members):

• FREE employee only coverage option for the medical, dental and vision plans plus FREE basic life insurance, EAP and long-term disability insurance!

• Adoption assistance and fertility benefits

• Maternity and paternity/partner paid leave

• 401k with generous match

• 11 Company-paid holidays

• PTO starting at 18 days/year

• Family member recognition program

• Continuing education/professional development reimbursement and time off

• Family member referral program