What are the responsibilities and job description for the Authorization Specialist position at Alliance Health System?

Job Description

Authorization Specialist

Authorization Specialist is responsible for obtaining prior authorizations for all treatment by successfully completing the authorization process with all commercial, automobile and workers compensation payers.

RESPONSIBILITIES

Review chart documentation to ensure patient meets medical policy guidelines
Prioritize incoming authorization requests according to urgency
Obtain authorization via payer website, fax or by phone and follow up regularly on pending submission
Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
Initiate appeals for denied or modified authorizations
Respond to clinic questions regarding payer medical policy guidelines
Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
Other duties as assigned

KNOWLEDGE, SKILLS, AND ABILITIES

Knowledge of treatment authorization and its direct impact on the practice's revenue cycle

Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively

Proficient use of CPT and ICD-10 codes

Excellent computer skills including Adobe, Excel and Internet use

Detail oriented with above average organizational skills

Plans and prioritizes to meet deadlines

Excellent customer service skills; communicates clearly and effectively

Ability to efficiently manage and prioritize time-sensitive tasks that arise

EDUCATION / EXPERIENCE REQUIRED

High School Diploma or GED

2 years medical prior authorization experience preferred

2 years experience with MD providers - Orthopedics & Pain preferred.

Job Type :

Full-time

Monday to Friday

Work Remotely :

Hybrid Remote

Benefits :

401(k) matching

Health insurance

Paid time off

Paid Holidays

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Authorization Specialist

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