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Job Description
- Req#: AUTHO001953
- Obtain and verify authorizations for diagnostic genetic testing,
- Review patient records and scheduled procedures to determine authorization needs.
- Communicate effectively with physicians' offices, insurance companies, and patients to facilitate authorization approvals.
- Track and monitor pending authorizations to ensure timely completion before scheduled service dates.
- Resolve denials related to authorization issues and work collaboratively with billing/coding teams to resubmit claims when needed.
- Stay up to date on payer policies, benefit changes, and authorization protocols.
- Assist with audits, compliance checks, and reporting as required by the RCM department.
- Maintain confidentiality of patient and financial information by HIPAA and company policy.
- College degree preferred or equivalent experience of 5 plus years
- Minimum of 5 years of experience in a medical billing or financial clearance role.
- Understanding of patient protections under HIPAA and proper handling of protected health information (PHI).
- Working knowledge of insurance policies, billing procedures, and claim terminology.
- Excellent communication and people skills.
- Detail-oriented with strong analytical and problem-solving abilities.
- Preference will be given to qualified candidates with experience with laboratory billing software, including Telcor, Xifin or Quadax.
- Strong knowledge of insurance guidelines, CPT/ICD-10 codes, and medical terminology.
- Excellent attention to detail and time management skills.
- Effective communication and problem-solving abilities.
- Proficiency in Microsoft Office Suite and healthcare software tools.
The primary responsibility of the RCM Authorization Specialist is to secure and verify prior authorizations for diagnostic testing. This position ensures timely and accurate processing to support proper billing, reduce denials, and promote a smooth patient experience.
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