Broad Function:

The Authorization Specialist is responsible for verifying and/or obtaining prior authorizations for all scheduled procedures, medications, outpatient exams, tests, scheduled and emergent admissions.

Major Responsibilities:

• Verify that prior authorization and pre-service requirements are met.
• Document eligibility, benefit, collection and authorization information in accordance with established authorization guidelines.
• Reviews accounts on a daily basis while meeting or exceeding all daily, weekly and monthly production goals.
• Interviews patients and responsible parties, obtaining accurate and complete personal and insurance data.
• Research patient accounts due to invalid or missing data and/ or missing authorization information to obtain the necessary information to ensure accurate, timely and complete claim submissions.
• Scans insurance cards, patient identification and required documents in the patient record for insurance verification.
• Coordinates with the Financial Counselor all self-pay and Medicare only patients in advance of the scheduled admission.
• Maintains appointments and schedules patients for various tests according to established guidelines.

Qualifications:

Requires a high school diploma. Two (2) years experience in a hospital business office setting required. Central Registration and scheduling experience in an acute care setting required. Effective customer relation skills, ability to organize and interpret data. Able to work effectively in a team environment. Ability to use a personal computer and related software.