Authorization Specialist

*This candidate should be local to the New England Area*

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

• 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