Authorization Specialist
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Job Description
Authorization Specialist securing insurance approvals, benefits, and precertifications for Lehigh Valley Health Network. Reviewing medical necessity, referrals, billing, and patient financial responsibility.
Responsibilities:
- Obtain benefits and authorizations for surgical procedures, diagnostic testing, medications, outgoing referrals, and other services
- Determine authorization protocols for each health plan
- Perform billing duties to ensure proper and timely payment from insurance carriers and patients
- Collaborate with physicians and provider office staff to ascertain appropriate authorization based on medical necessity and treatment plans
- Perform medical necessity checks to determine whether procedure and diagnosis support medical necessity
- Ensure authorizations comply with network policy and communicate exceptions to the ordering office, patient, and manager
- Communicate with insurance companies to obtain insurance verification, benefits, and precertification approvals
- Verify additional clinical information and insurance authorizations/referrals
- Review and monitor WQs/schedules to ensure proper and accurate authorization before patient visits
- Maintain compliance with benchmark data regarding accounts registered versus scheduled procedures
- Determine estimated patient financial responsibility using insurance verification information, payer contracts, and/or self-pay guidelines
Requirements:
- High School Diploma/GED with specialized training in insurance, coding, billing, or similar healthcare certificate programs
- 1 year in a healthcare setting with insurance verification/authorizations
- Familiarity with billing procedures and payer reimbursement
- Knowledge of patient rights and laws relative to those rights, such as HIPAA
- Proficient in utilization management processes, standards, and managed care
- Proficient in standard medical practices and insurance benefit structures
- Ability to lift and carry 25 lbs.
- Frequent sitting/standing and keyboard use
Benefits:
- Full-time employment
- Day shift schedule
- Monday-Friday, 8:00a-4:30p work schedule
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