Authorizations Specialist- Pediatric Hematology Oncology

Job Description

Job Description

SUMMARY: The Authorization Specialist completes authorizations and referrals for all medical services. In addition to reviewing the medical history of potential patients, verifies information provided by referring physicians and verifies insurance coverage. Also monitors the schedule for add-on patients, ensuring there are no conflicts and that prior authorizations are obtained prior to the scheduled appointment or procedure.

DUTIES AND RESPONSIBILITIES:

• Verifies information provided by referring physicians and verifies insurance coverage.
  • Analyze patient records and insurance policies to determine if procedures, treatments, or medications require prior authorization
  • Ensure patients are eligible for services and that insurance benefits are accurate
  • Interacts with healthcare providers, insurance companies, and patients to obtain and provide information needed for authorization decisions
  • Notify providers of potential coverage options
  • Communicate with patients about the authorization process and any potential delays or financial implications.
  • May suggest formulary/cheaper alternatives for expensive drugs.
  • May investigate any serious drug interactions with the requested drug.
• Completes authorizations and referrals for our medical services, including appointments and procedures.
  • Input new patient information and update information in our system
  • Compile and submit detailed authorization requests to insurance companies, including all necessary documentation
  • Research and resolve any issues or discrepancies related to authorization requests
  • Monitor and follow up on authorization requests to ensure timely processing
  • Investigate insurance denials and resubmit requests or appeal when necessary.
  • Complete billing documentation
• Monitors the schedule for add-on patients, ensuring no conflicts, and we have required prior authorization to move forward with appointment or procedure.
• Remain informed about healthcare industry regulations, trends and insurance policies
• Assist with other clerical tasks as needed and perform other related duties as assigned by management.

QUALIFICATIONS:

• High school diploma or general education degree (GED), or one to three months related experience and/or training, or equivalent combination of education and experience. Associate degree a plus.
• Some experience in medical billing or insurance authorization (strongly preferred).
• Knowledge of medical terminology.
• Basic computer skills.
• Attention to detail.