Authorization Specialist
Greater Boston, MA
Overview
The Authorization Specialist will be responsible for financially securing scheduled surgical procedures undertaken by the Vascular Care Group by verifying insurance eligibility and coverage of incoming patients.
Responsibilities
- Monitoring upcoming surgical cases, procedures and imaging on the physician’s calendars
- Responsible for identification and authorization of all codes that may be used throughout complex and variable patient treatments
- Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms necessary information to allow processing of claims to insurance plans
- Collaborates with other departments to ensure documentation is received prior to services
- Assists with medical necessity documentation to expedite approvals and ensure the appropriate follow-up
- Obtains, distributes, and documents referral authorization numbers
- Helps monitor cancellations, expirations, and changes to authorizations and referrals
- Documents authorizations and progress of authorizations in the patient’s chart
- Ensures all updates to documentation in client's file are completed in a timely manner
- Assists with the resolution of authorization related denials and billing holds
- Participates in providing ongoing training and education of staff as it relates to new processes to ensure timely confirmation of surgical cases
- Ensures compliance with appropriate industry regulations and State and Federal regulations
- Safeguard strict confidentiality of all health records, member information and meet HIPAA guidelines
- Assists with medical record requests, front desk tasks, and patient collections as needed
- Performs other duties as assigned
Requirements
- Bachelor’s degree preferred
- 1+ years of surgical insurance verification experience required
- Vascular experience preferred
- Working knowledge of eligibility, verification of benefits, and prior authorizations from various HMOs, PPOs, commercial payers and other funding sources
- Proficiency in establishing good working relationships with both internal and external vendors/customers, both in person and over the phone
- Outstanding written and verbal communication skills, with close attention to detail
- Demonstrated ability to analyze data and work independently within a fast-paced work environment
- Proficiency in technology, in particular Microsoft Office Suite
- Excellent organizational and prioritization skills
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