Insurance Authorization Specialist

Essential Job Functions Maintain work que assigned by the client Verify benefits and secure auth or inpatient and outpatient services. Performs other duties as directed. Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance. Key Success Indicators/Attributes [MM1] Ability to prioritize and multi-task in a fast-paced, changing environment.

Demonstrate ability to work in all work types and specialties. Demonstrate ability to self-motivate, set goals, and meet deadlines. Demonstrate leadership, mentoring, and interpersonal skills. Demonstrate excellent presentation, verbal, and written communication skills. Ability to develop and maintain relationships with key business partners by building personal credibility and trust.

Maintain courteous and professional working relationships with employees at all levels of the organization. Work in accordance with corporate and organizational security policies and procedures, understand personal role in safeguarding corporate and client assets, and take appropriate action to prevent and report any compromises of security within scope of position.

Demonstrate excellent analytical, critical thinking and problem-solving skills. Manage the Individual KRA’s as per the provided metrics. Understand client requirements and specifications of the project and ensure targeted collections are met on a daily / monthly basis. Meet the productivity targets of clients within the stipulated time.

Ensure timely follow-up on pending claims and prepare and maintain individual status reports. Skill in operating a personal computer and utilizing a variety of software applications is essential. Knowledge of coding convention and rules established by the AHIMA, American Medical Association (AMA), the American Hospital Association (AHA) and the Center for Medicare and Medicaid (CMS), for assignment of diagnostic and surgical procedural codes is an added advantage.

Knowledge of JCAHO, coding compliance and HIPAA HITECH standards affecting medical records and the impact on reimbursement and accreditation is an added advantage. Required Education and Experience Knowledge of medical and insurance terminology such as CPT, ICD-9, ICD-10, HCPCS, co-pay, deductible or co-insurance, and full understanding of hospital/physician billing.

Minimum 1-2 years’ experience in Medical Billing/Coding and experience with standard office software products. High School diploma or equivalent. Must be able to work PST time (11AM EST/10AM CST/8AM PST - 7PM EST/6PM CST/4PM PST) shift

• No flexibility Required Experience: 2+ years of front-end Epic experience required. 2+ years of direct referral and authorization processing experience preferred. Experience managing incoming and outgoing referrals. Knowledge of referral and authorization requirements and payer guidelines. Experience reviewing referrals for accuracy and required documentation. Ability to identify and resolve missing or incomplete referral information. Experience working high-volume referral workqueues. Strong follow-up and documentation skills. Ability to meet established productivity, quality, and turnaround-time expectations. Strong communication with patients, providers, and clinical teams.