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Authorization Specialist

Company: IHA
Location: Ann Arbor
Posted on: November 17, 2021

Job Description:

POSITION DESCRIPTION: This position is responsible for all aspects of the authorization/pre-certification process. May perform Medical Receptionist duties as necessary. ESSENTIAL JOB FUNCTIONS:

  • Obtains pre-certifications, insurance authorizations and testing for medical procedures.
  • Monitors inbox.
  • Obtains urgent authorizations same day, next day.
  • Verifies correct procedural and diagnostic codes and insurance verification.
  • Generates authorization information for physicians, patients and health plans.
  • Acts as a liaison among providers, staff, health plan administrators and hospital representatives.
  • Relays clinical information to health plan case managers for special procedure pre-certification and out-of-plan or out-of-network referrals; monitors authorizations or denials and follows up as necessary.
  • Communicates referral status to staff and physicians; ensures that authorizations have been processed accurately and in a timely manner to coincide with patient treatment plan.
  • Assists offices in, resolving billing discrepancies and any other referral/authorization issues.
  • Answers incoming calls.
  • Scans and files documents.
  • Supports other offices, attends required meetings and training, and participates in committees as requested.
  • May perform Medical Reception duties as necessary.
  • Assists with special projects and assumes additional duties as assigned. ESSENTIAL QUALIFICATIONS: EDUCATION : Undergraduate degree or Associate's degree in health care or a related field and specialized training or equivalent combination of education and experience. CREDENTIALS/LICENSURE : None MINIMUM EXPERIENCE : 4 years' experience with insurance referrals, prior authorization or other relevant medical office experience. POSITION REQUIREMENTS (ABILITIES & SKILLS):
  • Knowledge of medical terminology and procedures at the level needed to perform responsibilities.
  • Proficient knowledge of major health plans and insurance processes.
  • Excellent written (legible), verbal and face-to-face communication skills, including ability to effectively explain relevant insurance information to patients, as well as communicate with insurance plans and internal customers. Proper phone etiquette.
  • Proficient/knowledgeable in patient care procedures and organizational policies related to position responsibilities.
  • Service-oriented; responsive to customer needs and courteous in approach.
  • Proficient in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records, NextGen , PowerChart , EPIC, Microsoft Word /Excel/Outlook, intranet and computer navigation.
  • Ability to compute mathematical calculations.
  • Ability to work independently and collaboratively in a team-oriented environment; professional and friendly demeanor.
  • Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, patients, family members, vendors, outside customers and couriers.
  • Ability to cross-train in other areas of practice in order to achieve smooth flow of all operations.
  • Good organizational and time management skills to effectively juggle multiple priorities and time constraints.
  • Ability to exercise sound judgement and problem-solving skills.
  • Ability to handle patient and organizational information in a confidential manner.
  • Ability to travel to other office/practice sites and meeting and training locations.
  • Successful completion of IHA competency-based program within introductory and training period.

Keywords: IHA, Ann Arbor , Authorization Specialist, Other , Ann Arbor, Michigan

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