Authorization Specialist
Summary
Authorization Specialist verifying patient insurance eligibility and obtaining healthcare service authorizations for a home care and hospice provider. Daily work includes calling insurance companies, using web portals, collecting clinical data, and coordinating with referring offices to ensure timely payer reimbursement.
JOB SUMMARY
The Authorization Specialist is responsible for the day-to-day processes to verify patient eligibility and
obtain authorization for all exams scheduled to ensure timely payments from all accepted payer. The
typical daily work load consists of the following: eligibility investigations via phone and online web
portals, obtaining authorizations, collecting supporting clinical data from patients and/or referring offices and
updating all information.
RESPONSIBILITIES
- Manage the predetermination, authorization, and referral requirements of each health plan and meeting the requirements prior to the delivery of services.
- Contacts patients and/or referring offices for updated insurance information, medical records and/or additional clinical data to ensure that no more than 5% of all exams end up in pending clinical.
- Cross reference daily schedule and work queue to ensure that all scheduled exams are authorized forty-eight (48) hours prior to the date of service.
- Cross reference daily schedule and work queue to ensure that all same day add-ons are authorized prior to the completion of the exam; other payers must be authorized within twenty-four (24) hours following the completion of the exam.
- Work with each health plan to provide medical records and/or additional clinical data to ensure that 99% of all completed exams are approved for payment.
- Communicate and coordinate effectively with internal departments to ensure patient insurance information is accurate and updated.
LINE OF AUTHORITY
Reports to the Administrative Director Employee