Authorization Specialist

Job Title Authorization Specialist

Communicates clearly and effectively with patients, physicians, office staff and manager to resolve issues that may result in a denied or delayed authorization request. Demonstrates complete system knowledge, ability to run reports, document and manage referrals and authorizations, move correspondence, resolve eligibility and authorization holds, and other system tasks within the user's security access Demonstrates the ability to request, prepare, and recognize the documentation required to support the medical necessity for the service being authorized Provides the supervisor and manager with immediate feedback on issues affecting workflow, reimbursement, and customer service. Ensures that appropriate and accurate information is entered in the patient account Responds timely and collaborates effectively with the Reimbursement Department teams to limit denials and ensure proper reimbursement Collaborates with team members to meet department deadlines and benchmarks Demonstrates the ability to use the electronic tools and systems available to organize and process the daily work Anticipates and performs necessary job duties. Maintains patient confidentiality General Job functions: Expert in selecting the correct insurance package in Epic. Updates authorizations and claims to reflect the new insurance package. Expert in sorting work queues and reports to identify and process the daily work (Manage Schedules - Inbound Referral Report - Outgoing Referrals) Moves correspondence from the dashboard to the patient's account. Expert in generally accepted insurance benefit terms and processes. Expert in Communication (Case and authorization notation - Physician and Practice location staff Peers - Supervisor/Manager Payers) Expert in requesting and preparation of supporting documentation such as medical records, dictation, and orders. Expert in investigation of authorization denials and appeals (Insurance Patient) Education, Certification, Computer and Training Requirements: High School Graduate/GED Required. Vocational / Technical School / Diploma Program Preferred 2-4 years of related experience Preferred Experience with Standard Office Equipment (Phone, Fax, Copy Machine, Scanner, Email/Voice Mail) Preferred. Experience Standard Office Technology in a Window based environment & Microsoft Office Suite Required Total Rewards at VillageMDOur team members are essential to our mission to reshape healthcare through the power of connection. VillageMD highly values the critical role that health and wellness play in the lives of our team members and their families. Participation in VillageMD's benefit platform includes Medical, Dental, Life, Disability, Vision, FSA coverages and a 401k savings plan.