Authorizations Specialist (Finance)
Make calls to insurance companies for necessary surgical authorization of services for patient appointments.
Utilize online services from insurance companies to obtain surgical authorizations and/or gather information regarding patients' coverage for services.
Process all items for review in the practice management system and assigned to the department and/or third party software.
Handle all calls and/or written inquiries regarding appointment service surgical authorizations through resolution.
Research, correct and re-file any denied or rejected surgical authorization to maximize reimbursement.
Ensuring surgical authorizations are up to date, entering surgical authorizations into EHR, scanning and linking surgical authorizations to the patient's chart.
Extensive scheduling coordination with the surgery department, specialist and ancillary departments is needed.
Contact patient insurance provider to obtain authorization and confirm eligibility status for the surgery and verify patient's insurance coverage to include deductibles, out of pocket maximums, etc.
Using information obtained from insurance provider, calculates patient's payment amount to be paid to EmergeOrtho prior to surgery.
Document all information obtained in the practice management system to adequately relay said information to all staff and/or third party software.
Report rules, changes and other information affecting surgical authorizations to the Medical Records Supervisor.
Print reports from the practice management system to facilitate surgical authorization for appointment services for previously scheduled patients and patients added on.
Participate in educational and training opportunities to maintain current knowledge of payment policies Organize electronic patient records based on referral status.
Fills in for other account representative positions as needed.
Performs other duties as required and assigned by the Medical Records Supervisor.
Typical Physical Demands
The employee is required to sit for prolonged periods of the time and must be able to use hands and fingers to handle and to feel and arms to reach. The employee must be able to talk on the phone, hear and listen and be understood by the majority of the public. The employee may be occasionally required to stand and walk. The employee must be able to lift/and or move up to 10-15 pounds.