Authorization Specialist SSC
med4homeFranklin, TN
Authorization Specialist SSC
L4
med4homeFranklin, TNyesterday
Occupations
Medical Records SpecialistsHealth Information Technologists and Medical RegistrarsMedical Secretaries and Administrative AssistantsIndustries
General Medical and Surgical HospitalsOffices of Physicians (except Mental Health Specialists)All Other Miscellaneous Ambulatory Health Care ServicesInsurance Verification Specialist This employee verifies insurance, obtaining authorizations and documents needed to confirm order; responsible for communicating directly with the patient, doctors' offices, insurance companies, and centers associated with the patient's account.
Job Responsibilities:
- Prioritize incoming prior authorization requests
- Evaluate and triage prior authorization rejections to determine validity of the prior authorization
- Communicate as needed with patients regarding clinical information to be used when submitting the prior authorization
- Review patient chart documentation to ensure accuracy of prior authorization submissions
- Request, track, and obtain prior authorization from insurance carriers within time allotted for medical and services using my meds, fax, or verbal communication
- In a timely manner, follow up on prior authorizations that have been submitted with no response from the insurance carrier
- When justifiable, initiate appeals for denied authorizations
- Maintain patient files on Prior Authorizations tracker
- Compose letters for various situations to include medical necessity letters and appeal letters
- Use ICD-10 diagnosis codes accurately and properly in the submission of prior authorizations
- Contact patients via the platform to update the status of their prior authorization
- Assist patients with medication assistance programs to include obtaining signatures from providers, submit documentation to medical assistance programs, and tracking progress
- Demonstrate and apply knowledge of medical terminology high proficiency of general medical office procedures including HIPAA regulations
- Communicate with pharmacies/insurance carriers via phone, fax, or written communication
- Maintain a level of productivity suitable for the department
- Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format
- Evaluate options and make efficient decisions
- Maintain consistently accurate records
- Proficiency with multiple programs that include the use of internet and email
- Learn how to use new software AS400 LITE
Education and Experience: High School Diploma or equivalent (GED) required
Physical Demands:
The employee may frequently lift and/or move up to 10 pounds and may occasionally lift and/or move up to 25 pounds.
Apply now
Level
MidL4
Location
Franklin, TN
Occupation
Medical Records Specialists
Industry
General Medical and Surgical Hospitals
Posted
yesterday
To get sharper similar jobs, create your profile using the link below.