Insurance Authorization Specialist

Job Summary

Obtains pre-authorizations/pre-certification per payer requirements for services rendered and ensures authorization information is documented in the appropriate system. Your knowledge of insurance carriers and specific plan details will make you a valuable resource to patients, providers, and coworkers! Knowledge of medical codes and medical terminology required.

Duties and Responsibilities

• Obtains pre-authorizations/pre-certification per payer requirements for services rendered and ensures authorization information is documented in the appropriately in the system.
• Verifies physician orders are accurate.
• Ability to understand and communicate insurance co-pays, deductibles, co-insurances, and out of pocket expenses for point of service collections.
• Communication is maintained with providers, clinical staff, and patient in relationship to authorization status.
• Works and assists with the billing department in researching and resolving rejected, incorrectly paid and denied claims as requested.
• Helps to maintain a professional atmosphere for patients, family members and staff.
• Remains current with insurance requirements for pre-authorization and provides education within the departments and clinics on changes.
• Keep management informed of changes in authorization process, insurance policies, billing requirements, rejection or denial codes as they pertain to claim processing and coding.

Requirements and Qualifications

• High school degree or equivalent.
• Knowledge of CPT, HCPCS, and ICD-10 codes highly preferred.
• Medical terminology required.
• Ability to prioritize and perform multiple tasks with many interruptions.
• EMR experience required; MEDENT preferred.

Physical Demands

• Requires prolonged sitting and/or standing; primarily using phone and computer.
• Position requires manual and finger dexterity and hand-eye coordination.
• Involves standing, sitting, and walking.
• Team member will occasionally be asked to lift and carry items weighing up to 10 pounds; normal visual acuity and hearing are required.

The pay range for this position is determined based on several factors, including the candidate’s years of experience, qualifications, training, licenses, designations, and the overall market conditions.

This job description does not state or imply that the duties and responsibilities listed are the only ones required of this position.  Team members in this role will be required to perform other job-related duties at the discretion of the employer and may have additional duties assigned as necessary.  

Excelsior Orthopaedics and Buffalo Surgery Center are committed to the full inclusion of all applicants.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, or genetic information.