Authorizations Specialist
Required skills
- prior authorizations
- pain management procedures
- durable medical equipment
- medical policies
- insurance companies
- insurance data
- procedure requests
- medical necessity
- CPT codes
- diagnosis codes
Nice to have
- E-Clinical Works
Role summary
The Authorization Specialist is responsible for managing prior authorizations for pain management procedures and durable medical equipment (DME) at AZ Pain Doctors. This role involves determining authorization requirements, staying updated on medical policies, communicating insurance data, and ensuring accurate submission of authorizations with correct CPT and diagnosis codes. The specialist will review procedure requests, verify medical necessity, and ensure all necessary documentation is complete to prevent denials. Key responsibilities include entering authorization details, collaborating with the ASC/Procedure Center, and meeting task deadlines. A background in a medical professional setting, proficiency in CPT/ICD-10 coding, and knowledge of insurance websites and terminology are essential.
Description
The Authorization position is responsible for prior authorizations in relation to services provided at AZ Pain Doctors; such as pain management procedures and durable medical equipment (DME).
POSITION RESPONSIBILITIES:
* Determine if authorization is required for ordered services.
* Maintain up to date medical policies on various insurance companies and any relevant changes.
* Communicating important insurance data to appropriate staff.
* Reviews procedure requests for authorization needed based upon insurance standards while drawing upon experience and general knowledge. Reviews documentation or contacts the provider when necessary to supplement the order to prove medical necessity.
* Ensures appropriate documentation is available and complete before submitting the authorization to the insurance company to avoid repetitious submissions and denials.
* Submits all authorizations with correct CPT and diagnosis codes.
* Cross-references the procedure tasked against the doctor’s orders to ensure all services are submitted for correctly.
* Enters any authorization numbers and expiration dates into the task messages which are required for corresponding services.
* Work closely with the ASC/Procedure Center.
* Complete tasks by due dates.
* Verify if a blood thinner clearance is required from the patient's PCP or Cardiologist.
Requirements
ESSENTIAL SKILLS AND EXPERIENCE:
* Previous experience in medical professional atmosphere.
* Oral and written communication skills a must.
* Familiar with CPT ® and ICD-10 coding concepts.
* Proficient with government and private insurance.
* Understanding of insurance websites and form fields for authorization submission.
* Knowledge of medical and insurance terminology, Excel and computer skills, EMR - E-Clinical Works experience a plus.
* High School Diploma or equivalent.
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