Medical Authorization Specialist (MAS) At Bioventus, our business depends on developing our people. We invest in you and challenge you to be the best. We value our colleagues for their different perspectives and individual contributions, and our leaders listen. Our success rests on working together to achieve shared goals and rewards. Join a diverse team of global colleagues driven to help patients resume and enjoy active lives. As a Medical Authorization Specialist (MAS) you will draw upon your experience in reviewing medical records and insurance carrier policies to ensure that patients recovering from bone injuries receive the healing treatments they need. You will work with a team of medical authorization experts on processing orders quickly and accurately while adhering to the company's high performance standards and expectations.
Key Responsibilities:
Verify patient benefits and calculate patient's estimated financial responsibility.
Review insurance carrier policies to understand the nuances of various payers' coverage requirements for the company's products.
Review and interpret medical record documentation, such as patient history summaries, surgical notes, and treatment plans, to ensure an order meets requirements for insurance policy coverage.
Identify missing medical record documentation and communicate with company personnel to secure additional information as needed.
Submit pre-authorization requests with required demographic and clinical documentation in a timely manner to avoid delays in patient treatment.
Regularly and persistently communicate with insurance carriers to ensure timely processing of pre-authorization decisions.
Maintain complete, timely, and accurate documentation in the order processing system.
Attend team and department meetings and events.
Always operate compliantly by keeping patient data secure and confidential.
Comply with all health, safety and environmental policies, procedures, and job hazard analyses applicable to specified job activities, including medical evaluations as required by job function.
Complete all required training in a satisfactory and timely manner.
Hold oneself and others accountable to conduct business in a manner compliant with Bioventus' Code of Compliance, policies and procedures and internal controls applicable to the role.
Education and Experience:- In lieu of a degree, at least 2 years of medical authorization experience involving reviewing and interpreting medical records (Required)
- Successful completion of Exogen Certification (Required)
- Strong organizational skills: ability to manage detailed information, multi-task, manage time effectively, and prioritize appropriately (Required)
- Excellent written and oral communication skills with the ability to interface with customers, insurance providers, and company personnel at all levels (Required)
- Strong problem-solving skills and professional persistence (Required)
- Proficient using Microsoft Word, Excel, Outlook, and other department software (Required)
- Experience reviewing insurance plan policies across various insurers (Required)
- Experience verifying patient benefits and calculating estimated financial responsibility (Required)
- Familiarity with bone and fracture medical terminology (Required)
- Medical coding certification and/or experience with ICD-10 coding (Strongly Preferred)
