SUMMARY: The Authorizations Specialist is responsible for obtaining authorizations and referrals for our pediatric hematology/oncology office.

• Inputs new patient information and updates information in our EMR system
• Analyzes 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
• Notifies providers of potential coverage options
• Communicates with patients about the authorization process and any potential delays or financial implications.
• Interacts with healthcare providers, insurance companies, and patients to obtain and provide information needed for authorization decisions
• Compiles and submits detailed authorization requests to insurance companies, including all necessary documentation
• Completes/obtains authorizations and referrals for services, including appointments, procedures, infusions, and medications
• Researches and resolves any issues or discrepancies related to authorization requests
• Monitors and follows up on authorization requests to ensure timely processing
• Investigates insurance denials and resubmit requests or appeals when necessary.
• Monitors schedule for potential issues
• Remains informed about healthcare industry regulations, trends and insurance policies
• Performs 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.
• Strong understanding and experience in medical billing or insurance authorization.
• Knowledge of medical terminology.
• Ability to use Microsoft Office- Outlook, Word, Excel,
• Acute attention to detail and strong organization skills.

• Inputs new patient information and updates information in our EMR system
• Analyzes 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
• Notifies providers of potential coverage options
• Communicates with patients about the authorization process and any potential delays or financial implications.
• Interacts with healthcare providers, insurance companies, and patients to obtain and provide information needed for authorization decisions
• Compiles and submits detailed authorization requests to insurance companies, including all necessary documentation
• Completes/obtains authorizations and referrals for services, including appointments, procedures, infusions, and medications
• Researches and resolves any issues or discrepancies related to authorization requests
• Monitors and follows up on authorization requests to ensure timely processing
• Investigates insurance denials and resubmit requests or appeals when necessary.
• Monitors schedule for potential issues
• Remains informed about healthcare industry regulations, trends and insurance policies
• Performs other related duties as assigned by management