MEDICAL AUTHORIZATION SPLST
TOTAL ORTHO SPORTS AND SPINE
METHODIST MEDICAL GROUP
Allen, TX, 75013
Full-time · Day · 8am to 5pm Mon-Fri
Req # 20062724
The Medical Authorization Specialist professional responsible for verification of medical coverage, along with notification, prior authorization, and/or pre-determination of healthcare benefits for proposed medical services, to ensure reimbursement for rendered care. This position routinely works with physicians, clinic support staff, case managers, nurses, insurance utilization management staff, and patients to initiate pre-authorization and resolve issues that arise during the prior authorizations process. Supports and promotes the vision, mission, and strategic plans of Methodist Health System
Your Job Requirements:
- High School Graduate or equivalent. Some college preferred
- 1 year of prior clinical and/or insurance experience.
- Knowledge of billing practices and clinic policies and procedures.
- Knowledge of ICD-9, ICD-10 and CPT codes for clinic operating policies.
- Strong proficiency using Microsoft Office products
- Strong oral and written communication skills
- Detail oriented, logical, and methodological approach to problem solving
Your Job Responsibilities:
- Communicate clearly and openly
- Build relationships to promote a collaborative environment
- Be accountable for your performance
- Always look for ways to improve the patient experience
- Take initiative for your professional growth
- Be engaged and eager to build a winning team
- Ability to interpret Payer Clinical Policies in reference to practice procedures.
- Contacts Payer(s) in a timely manner to obtain, monitor, expedite, and track pre-authorization/pre-certification requests for planned services. Monitors changes in Authorization requests daily, to ensure a faster mode of notification retrieval.
- Identifies and provides accurate CPT/ ICD codes on the authorization request.
- Maintain appropriate logs or reports according to professional, state and federal requirements
- Refers authorization requests that require clinical judgment to the Provider, and/or Billing Manager, when necessary.
- Advises Manager of all patient complaints, and asks for assistance if problem resolution has not occurred with the patient
- Adheres to patient and office confidentiality guidelines as outlined by the policies and procedures of the office and hospital system as well as HIPPA, red flag regulations, and any other polices that relate to compliance to federal program guidelines
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