Authorization Specialist

Omega Hospital•Metairie, LA

About The Position

Summary Responsible for all aspects of the prior authorization process. Responsibilities include collecting all necessary documentation, communicating with providers for additional information and completion of the required prior authorization in order to proceed with procedure. Complete, timely and accurate identification and submission of authorization requests to the payers, including but not limited to prior authorizations, retro authorizations, and single case agreements. Essential Functions Responsible for the verification of insurance information, as well as documenting the need for authorization or lack of need for authorization in CPSI to facilitate claims processing. Contacts insurance carriers to secure authorization information. Documents authorization information in CPSI to ensure admissions are approved. Acts as a resource for the department personnel as it relates to the authorization process and documentation required for services. Assures that authorizations are obtained prior to date of service and communicates with scheduling/billing manager regarding status of authorizations. Relays authorization approval, peer to peer request or denial status to the Billing/Scheduling Manager and physician's office. Scans authorization confirmation/denials to physician's office. Submit retro-authorization to the payers within 48 hours of patient procedure. Assists the billing manager, billers, schedulers, receptionist and/or medical records coordinator. Performs other duties as assigned.

Requirements

High School graduate or equivalent (GED)
Previous authorization experience required
Experience with patient admissions and verification of insurance coverage
Professional verbal and written communication skills
Basic computer knowledge
Strong organizational skills and detail oriented
Ability to multi-task

Responsibilities

Collecting all necessary documentation for prior authorizations
Communicating with providers for additional information
Completing required prior authorizations
Identifying and submitting authorization requests to payers
Verifying insurance information
Documenting the need for authorization in CPSI
Contacting insurance carriers to secure authorization information
Documenting authorization information in CPSI
Acting as a resource for department personnel
Ensuring authorizations are obtained prior to date of service
Communicating authorization status with scheduling/billing manager
Relaying authorization status to the Billing/Scheduling Manager and physician's office
Scanning authorization confirmations/denials to physician's office
Submitting retro-authorizations within 48 hours of patient procedure
Assisting the billing manager, billers, schedulers, receptionist and/or medical records coordinator
Performing other duties as assigned