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GI Associates

Medical Authorization specialist

GI Associates, Milwaukee, Wisconsin, United States, 53244

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Overview At GI Associates we believe in striving for the best outcomes for our patients, employees, and community.

GI Associates is looking for motivated people to join our growing independent gastroenterology practice. Our nationally recognized physicians and dedicated team are patient-focused and provide compassionate, collaborative care to patients across Southeast Wisconsin.

Benefits GI Associates provides an excellent work-life balance and amazing benefits package including:

No weekends

No Holidays

PTO & paid anniversary day

7% GI Associates retirement contribution & 401(k) plan

Medical, dental & vision insurance

Flexible spending plan

Short- & long-term disability

Basic & supplemental life insurance

Position Summary A Medical Authorization Specialist

is responsible for determining insurance eligibility/benefits and ensuring pre-certification/referral requirements are met for both the facility and professional services.

Position Responsibilities

Monitoring and distributing faxes received internally for the department

Works with patients to assist them with insurance requirements and coverages for care

Answers incoming calls to a phone queue in a timely, accurate and professional manner

Communicates with outside provider offices, hospital staff, and independent facilities to obtain accurate insurance, authorizations and referrals

Verifies eligibility and benefit levels to ensure adequate coverage at correct site of service

Obtains pre-certification, authorization, and referral approval for required services for both the facility and professional services

Ensures timely and accurate insurance authorizations/referrals are in place prior to services being rendered

Provides detailed documentation and communication with both payors and clinicians to obtain prior authorizations

Obtains and submits clinical information to support medical necessity

Coordinates peer-to-peer reviews, when required by payors

Completes accurate documentation in our practice management system

Assist with denials related to pre-certification as needed

Respond to internal/external emails and inquiries in a timely, accurate and complete manner

Minimum Qualifications

Works independently and efficiently, being able to prioritize the workflow

Attention to detail

Familiar with ICD-10 and CPT codes

Familiar with Medical Terminology

Communicates effectively and professionally

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