Job Summary
The Authorization Specialist II position is responsible for reviewing clinical documentation per HCPCS, CPT, and ICD-10
codes, initiating, submitting, and follow up on authorizations per payer portals, and by faxing requests. Complete data
entry and administrative support functions for the organization’s Billing Department.
Essential Functions, Duties, and Responsibilities
Tasks may include (based on services offered within assigned region), but not limited to the following:
- Organized and detail oriented.
Excellent time management skills
Verify insurance coverage and eligibility.
Knowledge of CPT, HCPCS, and ICD-10 codes.
Review of procedure orders and documentation to determine necessity of prior authorization.
Ability to run account detail report, unbilled report, and any other claims detail report for proper follow up as
needed.
- Provide feedback to departments, sites, and payers on project status.
Strong written and communication skills with providers, team members and clients.
Detailed documentation of authorization numbers and process for each prior authorization.
Maintain accurate patient medical records.
Make status calls to insurance companies and utilize payer portals to follow on submitted authorization for
reimbursement.
- Identify, analyze, report on trends and analysis of all payer issues and report it to the Revenue Cycle Manager.
Research authorization denial reasons per payers or by contacting the funders to maximize claim reimbursement.
Follow company processes related to submission of corrected authorizations and appeals.
Maintain tracking sheet of pending/resolved issues and historical payer issues.
Understands and adheres to RI International compliance standards as they appear in the Code of Conduct and
Conflict of Interest Policies.
- Performs other duties as assigned.
Qualifications: Education, Experience, and Skills
Required:
- High school diploma or equivalent.
2-3 years of authorization experience required.
Working knowledge of CMS guidelines, contracted insurance guidelines and coding policies.
Detailed oriented, reliable, and able to multi-task in a fast-paced, high-volume work environment.
Microsoft Suite and Excel knowledge (intermediate to advanced).
Ability to maintain a high level of confidentiality (HIPAA guidelines and regulations) and professionalism.
Must have a valid driver license and be 18 years of age.
Must have the ability to walk, climb, stoop, reach, crawl, crouch, kneel, push, pull and lift a minimum of 10lbs.
Must have excellent written and verbal communication, with particular emphasis during telephone calls, follow-ups,
and in-person correspondence.
- We are a Second-Chance Employer
o Must be able to pass a seven-year background check.
o Must be able to pass substance abuse testing.
o Must be able to pass three-year motor vehicle report and meet minimum eligibility requirements criteria of
insurance carrier (if driving is required for this position).
Associated Knowledge, Skills, and Abilities
- Above average computer skills including databases, spreadsheets, interface file maintenance and related computer
programs designed for billing, coding, and accounting purposes.
- Ability to focus on the big picture while attending to multiple detail requirements in a changing environment.
Ability to analyze and interpret data.
Ability to formulate, recommend and implement solutions.
Ability to adapt to change in the workplace and demonstrate the ability to work collectively within a diverse team
environment.
- Ability to use critical thinking and reasoning skills to solve a problem.
Ability to provide guidance and feedback to help others strengthen specific knowledge/skill areas.
Ability to find a solution for or to deal proactively with work-related problems.
Core Job Competencies
To perform the job successfully, an individual should demonstrate the following job competencies:
- Teamwork – Working as a productive member of a cohesive group toward a common goal and contributing to team
development and effective team dynamics.
- Quality of Work – Degree of proficiency in performing the job; accuracy, neatness, skill, thoroughness, economy of
materials.
- Customer Focus – Knowing the (internal and external) customer business needs and acting; accordingly, anticipating
customer needs and giving high priority to customer satisfaction and customer service.
- Job Knowledge – Understanding of the job, including procedures, techniques, equipment, etc. Utilized prior
training/experience. Acquires the knowledge needed to perform the job.
- Accountability – Accepting responsibility that results in anticipation/prevention of problem areas from actions, and
problem solving inside and outside the department/organization.
License/Certification
Preferred:
- N/A
Working Environment
Work is performed in a typical interior office setting with moderate noise levels in addition to managing multiple
projects at one time that may be interrupted frequently to meet the needs and request of team members, customers,
and management or C-level team members.
Working Conditions/Physical Requirements
Physical activities include typing, talking, and hearing in a sedentary work environment. Exerting up to 10 pounds of
force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move
objects, including the human body. The worker is required to have close visual acuity to perform an activity such as:
preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading; visual
inspection involving small defects, small parts, and/or fabrication parts at distances close to the eyes.
Equipment or Machines Routinely Used in This Position
Required to use keyboard, mouse, and other electronic accessories in addition to fax machines, monitors, computers,
laptops, mobile devices, tablets, presentations remotes, televisions, printers, scanners, postage meter, multi-line phone,
headset or Bluetooth related devices.
Review Procedures
A regular review and evaluation of the employee’s work performance will be conducted.
About RI International:
Our mission is to empower people to recover, succeed in accomplishing their goals, find meaning and purpose in life, and reconnect with themselves and others. Our vision is to activate the next generation of frame-breaking healthcare innovation to support people beyond their behavioral health needs and succeed in the community where they live, work, and play.
Please Note :
epokagency.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, epokagency.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.