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 jobs in New York

See all jobs on JobTailor

Authorization Specialist II