Authorization Representative Job in Northeast Orthopedics and Sports Medicine

Reports To: Office Manager
Job Summary:
The authorization specialist is responsible for obtaining prior authorizations for all medications, durable medical equipment, and diagnostic test for all workers compensation and commercial payers.
Primary Job Responsibilities:
Review chart documentation to ensure patient meets medical policy guidelines.
Prioritize incoming authorization requests according to urgency.
Obtain authorization via payer website, secure email, fax or phone and follow up regularly on pending cases
Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
Initiate appeals for denied authorizations
Communicate with patients regarding their authorization status and schedule when appropriate
Document all communications clearly in patients EHR file
Cover front desk and check out when needed
Other activities as assigned
Knowledge of procedure authorization and its direct impact on the practice’s revenue cycle
Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively.
Basic understanding of human anatomy, specifically musculoskeletal
Proficient use of CPT and ICD-10 codes
Excellent computer skills including Excel, Word and EHR systems
Detail oridented with above average organizational skills
Plans and prioritizes to meet deadlines
Excellene customer service skills; communicates clearlyl and effectively
Ability to multitask and remain focused while managing a high-volume, time-sensitive workload.
Knowledge of all NEOSM medical practice policies and protocols
Knowledge of HIPAA rules and regulations
Skill in communicating effectively with physicians/clinicians, staff and patients.
Skill in putting information in preferred medical records system, meeting clinical standards
Skill in dealing with masses of information in organized manner.
Job Type: Full-time
Dental insurance
Health insurance
Paid time off
Vision insurance
8 hour shift
Day shift
Monday to Friday
COVID-19 considerations:All employees are required to be vaccinated. All employees and patients required to be masked at all times. Strict COVID19 policies in the office setting.
High school or equivalent (Preferred)
Insurance verification: 1 year (Preferred)
Work Location: One location

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