Authorization Specialist

Senior PsychCare is hiring for an Authorization Specialist.  The position is primarily responsible for obtaining required pre-authorizations and helping to process referrals for all services accurately and timely.  

 
ESSENTIAL FUNCTIONS: 

Prioritize incoming authorization requests according to urgency 

Initiate, verify, and complete procedure authorization/referral process 

Resolves day-to-day issues pertaining to pre-authorization, as needed 

Monitor provider network status 

Obtain authorization by fax, payer website or by phone and follow up regularly on pending cases. 

Notify appropriate departments for approvals and denials 

Initiate and assist with appeals for denied authorizations 

Effectively maintain, monitor, and update payer medical policy guidelines to manage authorization requirements 

Request, review, and submit necessary patient documentation as needed to ensure approval of authorization  

Collaborate with healthcare providers and insurance companies to resolve any issues related to prior authorization 

Stay current with changing insurance policies and regulations 

Effectively utilizes ICD 10, CPT, modifiers and/or other codes according to coding guidelines when requesting Authorizations 

Communicates effectively with provider and/or all appropriate parties regarding missing information such as CPT, diagnoses codes, documents, clinical reports, etc. to ensure proper authorization processing 

Communicates effectively with other departments regarding changes and/or updates with patient accounts and status 

Manages the status of accounts and identify inconsistencies 

Responds to billing inquiries 

Uses downtime efficiently; is aware of team members workload 

Makes recommendations on workflow improvement as needed 

 
KNOWLEDGE, SKILLS, AND ABILITIES: 

Knowledge with in and out of network insurances, insurance verification, and process for prior authorization 

Familiarity with ICD-10 and CPT codes and procedures 

Ability to review and understand patient medical documentation 

Ability to independently identify and understand medical necessity requirements 

Task-oriented and organizational skills; ability to complete tasks timely 

Detail-oriented focus; being careful about detail and thorough in completing work tasks 

Ability to work independently and as a team 

Ability to adapt with flexibility 

Effective communication skills (written/verbal) 

 
EDUCATION AND EXPERIENCE: 

High school diploma or GED 

Three (3) years authorizations experience with Medicare/Medicaid MCO’s (Behavioral Health experience Preferred) 

Strong working knowledge of insurance coverages and billing processes. 

Experience with basic desktop software including Microsoft Office