Position Purpose:

The Authorization Specialist records referrals and authorizations and works closely with physicians, patients, and payers to achieve a positive impact on the outcome and quality of care rendered to the patients. The specialist is responsible for knowing: medical insurance processes, health insurance law, policy, and regulations, insurance records and paperwork administration, insurance office administration, health/medical insurance software applications, medical technology, and is capable of good communication skills.

The specialist assesses all patient insurance submissions to ensure they are complete and accurate. As the control point for all insurance authorization forms and control and offers constructive feedback regarding questions to ensure all members of the team adhere to federal guidelines and standards that lead to successful insurance approval.

Key Responsibilities:

• Obtain pre-certifications for all modalities for Prima-Care and outside medical providers
• Checks each modality to see if they require authorization
• Recognizes and uses appropriate website to obtain authorization
• Recognizes appropriate diagnosis codes (using schedule / ECW)
• Calls or faxes additional clinical notes to insurance company in order to get authorization approval
• Prints authorization from off website and enters authorization on schedule for billing
• Checks all pending authorizations (on website or with a call to insurance company)
• Checks authorizations from previous day while Radiology tech documents the final computer code that was performed
• Calls insurance company for appropriate authorization code
• Initiates and manages all components of pre-authorization /final authorization process for diagnostic services
• Acts as liaison between the diagnostic services department, providers, health plans, vendors, and patients
• Coordinates the flow of information to central scheduling team once a valid insurance approval is obtained for each patient
• Assists Central Scheduling Supervisor with complaint resolution and solutions related to patient prior authorization challenges.

Other responsibilities as requested