Authorization Specialist

• Responsible for verifying insurance policy benefit information, and securing payer required authorizations.
• Obtains accurate and timely pre-authorizations for professional services prior to the patient's visit.
• Verifies insurance coverage via system tools, payer portals, etc. and updates changes in billing system.
• Confirms providers participation status with patients insurance plan/network.
• Determines payer referral and authorization requirements for professional services.
• Contacts patient and PCP to secure payer required referral for planned services.
• Documents referral in practice management system.
• Researches system notes to obtain missing or corrected insurance or demographic information.
• Reviews clinical documentation to ensure criteria for procedure meets insurance requirements.
• Initiates authorization and submits clinical documentation as requested by insurance companies.
• Follows through on pre-certifications until final approval is obtained.
• Communicates with surgical coordinators regarding authorizations status or denials.
• Submits appeals in the event of denial of prior authorizations or denial of payment following procedures.
• Serves as back-up to Authorization-Referrals Specialist III.

Authorization Specialist II verifying insurance information for ColumbiaDoctors

Authorization Specialist II

Authorization Specialist II responsible for verifying insurance benefit information and securing authorizations for ColumbiaDoctors, a major healthcare provider.

• Obtain and maintain prior authorization status for NELC patient medications/therapies
• Work closely with the clinical review department to obtain documentation needed to complete the authorization process
• Obtain needed documentation to support the billing department in meeting payer requirements for patient accounts

Authorization Specialist obtaining patient medication authorizations for home infusion provider

Remote Authorization Specialist for New England Life Care seeking to obtain patient medication authorizations and support billing processes. Requires 3 years authorization or billing experience in specified US states.

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Authorization Specialist II

Authorization Specialist