Job Description

AUTHORIZATION SPECIALIST

Our highly professional Authorization Specialist is responsible for pre-certification and pre-authorization for procedures, treatment(s), and testing. The Authorization Specialist has a high proficiency for communicating internally as well as with patients and their families regarding the needs/status of prior authorization. This position reports to the Practice Administrator.

PRIMARY RESPONSIBILITIES

· Works directly with the insurance companies, Chicago ENT staff/providers, and external referring staff/providers to ensure an efficient authorization process.

· Daily monitors schedules and orders to begin prior authorization.

· Accurately verifies patient insurance/benefits before beginning prior authorization.

· Communicates plan limitations or non-covered services with ordering physician and patient.

· Monitors prior authorization from initiation to completion:

o Submits all ordered CPT and ICD-10 diagnosis codes.

o Submit necessary clinical information, coordinate peer-to-peer calls, and appeals denied authorizations.

o Once approved, alerts the patients and providers, and documents status on EMR appointment.

o Records prior authorization/reference numbers in the EMR for billing department.

· Answer, screen, respond, and rout phone queries in addition to checking voicemails, telephone encounters, faxes, and other inbound communication.

· Cooperate and maintain good rapport with admin staff, medical staff, other departments, and visitors.

· Review denied claims and proactively work with billing to identify processing issues and errors.

· Act as an expert to answer questions from patients and staff.

· Maintain a professional approach with confidentiality regarding all patient information.

· Performs other selected administrative duties as directed by physicians or Practice Administrator.

REQUIRED QUALIFICATIONS

· Two years of medical insurance verification and authorization experience.

· Excellent organizational skills and attention to detail.

· Excellent verbal and written communication, and interpersonal skills.

· Excellent time management skills.

· Strong analytical and problem-solving skills.

· Must have the ability to remain calm in stressful situations, to be flexible, to work well with many interruptions and to be able to multi-task.

· Must exhibit and promote a high level of customer service, hospitality, curiosity and friendliness towards all patients, employees, and the overall facility.

· Bilingual preferred.

· Proficiency in completing pre-authorizations via insurance web sites.

SUPERVISORY RESPONSIBILITY

This position has no supervisory responsibility.

CERTIFICATES, LICENSES, REGISTRATIONS

None required.

ENT is a drug-free environment and an Equal Opportunity Employer. We offer competitive salaries and benefits, including medical/dental, life and disability coverage, generous vision benefits, a 401 (k) plan with a match, vacation time, and weekends and major holidays off.

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