Authorization Specialist

• Obtain benefits and authorizations for surgical procedures, diagnostic testing, medications, outgoing referrals, and other services
• Determine authorization protocols for each health plan
• Perform billing duties to ensure proper and timely payment from insurance carriers and patients
• Collaborate with physicians and provider office staff to ascertain appropriate authorization based on medical necessity and treatment plans
• Perform medical necessity checks to determine whether procedure and diagnosis support medical necessity
• Ensure authorizations comply with network policy and communicate exceptions to the ordering office, patient, and manager
• Communicate with insurance companies to obtain insurance verification, benefits, and precertification approvals
• Verify additional clinical information and insurance authorizations/referrals
• Review and monitor WQs/schedules to ensure proper and accurate authorization before patient visits
• Maintain compliance with benchmark data regarding accounts registered versus scheduled procedures
• Determine estimated patient financial responsibility using insurance verification information, payer contracts, and/or self-pay guidelines