The Authorizations Specialist I is responsible for securing medical authorizations from third party payers (commercial and government) for post-acute services; will be instrumental in obtaining written documentation, tracking, prioritizing, and reporting outcomes of each authorization request.

 

Summary:

Completes full financial clearance of upcoming scheduled visits (insurance verification, pre-registration, authorization) Submits authorization requests, including applicable clinicals, to payer authorizing services. Follows-up with payer to receive a determination on authorization, escalating as necessary to ensure pre-service approval. Accomplishes flexible work assignments based on daily priority, following established guidelines.

 

Job Duties:

Completes patients’ Facesheet with all necessary demographic / insurance information, and forms or documents in preparation for check-in or admission. Coordinates with payer, referring department, and patient on obtaining a valid authorization pre-service (including submitting necessary clinicals, following up on missing information or pre-service denials, documenting approved authorizations timely, etc.). Maintains and updates patient’s accounts for medical and financial eligibility. Required to operate within Epic Workqueues to stay up to date with all upcoming visits requiring this review (i.e., obtaining all necessary billing, insurance and other demographic information from patient or insurance representative, obtaining necessary authorizations, etc.). Coordinates with patient as required to obtain any missing information or to inform the patient of the status of their accounts / amount due for service. Discusses, arranges, and receives payment of bills with patient or representative, as able/requested.