Authorization Specialist
| Company | Traditions Health |
|---|---|
| Location | Franklin, TN, USA |
| Salary | $Not Provided – $Not Provided |
| Type | Full-Time |
| Degrees | |
| Experience Level | Mid Level |
Requirements
- High School Diploma or GED
- Associate Degree Preferred
- Minimum 2 years experience in a medical-related field (preferably Home Health/Hospice)
- 2 years of medical prior authorization experience preferred
- Strong knowledge of medical coding systems, including ICD-10
- Familiarity with insurance verification processes and procedures
- Proficiency in using medical office software and electronic health record systems
- Attention to detail and ability to maintain accurate records
- Excellent communication skills, both verbal and written
- Ability to work collaboratively with healthcare providers, insurance companies, and patients
- Knowledge of procedure authorization and its direct impact on the company’s revenue cycle
- Understanding of payer medical guidelines while utilizing these guidelines to manage authorizations
- Excellent computer skills, including Excel, Word, and Internet use
- Detail-oriented with above-average organizational skills
- Plans and prioritizes to meet deadlines
- Excellent customer skills; communicates clearly and effectively
- Ability to multitask and remain focused while managing a high-volume, time-sensitive workload
- Reliable transportation with valid and current auto insurance
Responsibilities
- Obtaining authorizations from insurance companies for medical procedures and services
- Reviewing medical records and coding information to ensure accuracy and compliance with HIPAA regulations
- Collaborating with healthcare providers and insurance companies to resolve authorization issues
- Maintaining accurate and up-to-date records of authorizations and insurance information
- Prioritize incoming authorization requests according to urgency
- Obtain authorization via payer website/portal or by phone/fax and follow up regularly on pending cases
- Obtain appropriate medical records from the source system to submit with prior auth per payor-specific guidelines
- Maintain individual payer files to include up-to-date requirements needed to obtain/initiate appeals for denied authorizations successfully
- Respond to agency questions regarding payer prior auth/medical guidelines
- Other duties as assigned
Preferred Qualifications
- 2 years of medical prior authorization experience preferred
- EMR/Software: HomeCare Home Base, Availity, Microsoft Platforms Preferred