Authorizations Specialist - Conservative

Authorizations Specialist Location: REMOTE or HYBRID Entity: Alliance Health System Reports To: Director of Authorizations Authorization Specialist is responsible for obtaining prior authorizations for all treatment by successfully completing the authorization process with all commercial, automobile and workers compensation payers.

RESPONSIBILITIES

• Review chart documentation to ensure patient meets medical policy guidelines
• Prioritize incoming authorization requests according to urgency
• Obtain authorization via payer website, fax or by phone and follow up regularly on pending submission
• Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
• Initiate appeals for denied or modified authorizations
• Respond to clinic questions regarding payer medical policy guidelines
• Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
• Other duties as assigned

KNOWLEDGE, SKILLS, AND ABILITIES

• Knowledge of treatment 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
• Proficient use of CPT and ICD-10 codes
• Excellent computer skills including Adobe, Excel and Internet use
• Detail oriented with above average organizational skills
• Plans and prioritizes to meet deadlines
• Excellent customer service skills; communicates clearly and effectively
• Ability to efficiently manage and prioritize time-sensitive tasks that arise

EDUCATION/EXPERIENCE REQUIRED

• High School Diploma or GED
• 2 years medical prior authorization experience preferred
• 2 years experience with MD providers - Orthopedics & Pain preferred.

Job Type:

• Full-time
• Monday to Friday

Benefits:

• 401(k) matching
• Health insurance
• Paid time off
• Paid Holidays

Background Check Requirement: Employment is contingent upon the successful completion of a background check, which may include verification of employment history, education, criminal records, and other relevant information as permitted by law.

High school diploma or GED; 2 years medical prior authorization experience preferred; 2 years with MD providers in Orthopedics & Pain preferred; proficient with CPT and ICD-10 codes; excellent computer skills including Adobe and Excel.

Key Responsibilities

• obtaining prior authorizations
• reviewing chart documentation
• initiating appeals

Skills & Tools

Adobe, Microsoft Excel

Job Details

• Category: Healthcare Services - Allied Health
• Seniority: Entry Level
• Commitment: Full Time
• Workplace: Remote — United States
• Salary: USD 50,000 – 55,000 / year
• Languages: English

Benefits

• 401k matching
• Generous paid time off
• Retirement plan

About Alliance Health System

A health management company providing non-medical services that let physicians, group practices and hospitals focus on clinical care. — Industry: Healthcare

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