Boulder, CO
Prior Authorization Specialist
Boulder, CO, Boulder, Colorado, United States, 80301
Job Overview:
The Authorization Specialist is responsible for pre-authorizing services including MRI, therapy, surgery, and durable medical equipment (DME) for the practice. This role includes verifying insurance benefits, obtaining pre-certifications and authorizations from payors, submitting necessary documentation, and assisting patients with understanding their financial obligations. The specialist will monitor the authorization status of scheduled patients and reschedule appointments as necessary pending completed authorization.Department:
AdministrativeReports to:
Prior Authorization ManagerSchedule/Type:
Full-Time M-F/ HourlyOvertime Status:
Non-exemptWage:
$20-32 per hour, commensurate with experienceEssential Job Responsibilities:Submit and follow up on authorization requests with insurance companies for internal MRI, therapy, surgery, and DME orders.Verify order contents and insurance coverage upon receipt, obtain pre-authorization, and communicate benefits eligibility and financial details to patients and practitioners.Notify patients and practitioners of any services requested that are not authorized by insurance.Review upcoming schedules for authorization status and contact patients with payment/rescheduling options if authorization is not obtained.Utilize intraoffice communication and resources to support the authorization process.Prioritize workflow based on authorization timeframes, insurance requirements, and urgency.Obtain retroactive authorizations as needed.Maintain accurate and timely documentation and records for continuity of patient care.Perform other duties as assigned.Education/Experience:High school diploma or GED required. College degree preferred.Minimum of 2 years of experience in billing/authorization preferred.Experience in an orthopedic or medical setting preferred.Familiarity with pre-authorization, pre-certification, and health insurance claims processing preferred.Performance Requirements:Knowledge of:
insurance processes, third-party payers, basic coding (CPT, ICD-9), Medicare compliance, OSHA, HIPAA, and relevant regulations.Skills in:
written and verbal communication, customer service, math, and organization.Ability to:
prioritize tasks, multitask, and work effectively in a fast-paced environment while maintaining cooperative relationships with staff and patients.Closing Date:
September 27th, 2024
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The Authorization Specialist is responsible for pre-authorizing services including MRI, therapy, surgery, and durable medical equipment (DME) for the practice. This role includes verifying insurance benefits, obtaining pre-certifications and authorizations from payors, submitting necessary documentation, and assisting patients with understanding their financial obligations. The specialist will monitor the authorization status of scheduled patients and reschedule appointments as necessary pending completed authorization.Department:
AdministrativeReports to:
Prior Authorization ManagerSchedule/Type:
Full-Time M-F/ HourlyOvertime Status:
Non-exemptWage:
$20-32 per hour, commensurate with experienceEssential Job Responsibilities:Submit and follow up on authorization requests with insurance companies for internal MRI, therapy, surgery, and DME orders.Verify order contents and insurance coverage upon receipt, obtain pre-authorization, and communicate benefits eligibility and financial details to patients and practitioners.Notify patients and practitioners of any services requested that are not authorized by insurance.Review upcoming schedules for authorization status and contact patients with payment/rescheduling options if authorization is not obtained.Utilize intraoffice communication and resources to support the authorization process.Prioritize workflow based on authorization timeframes, insurance requirements, and urgency.Obtain retroactive authorizations as needed.Maintain accurate and timely documentation and records for continuity of patient care.Perform other duties as assigned.Education/Experience:High school diploma or GED required. College degree preferred.Minimum of 2 years of experience in billing/authorization preferred.Experience in an orthopedic or medical setting preferred.Familiarity with pre-authorization, pre-certification, and health insurance claims processing preferred.Performance Requirements:Knowledge of:
insurance processes, third-party payers, basic coding (CPT, ICD-9), Medicare compliance, OSHA, HIPAA, and relevant regulations.Skills in:
written and verbal communication, customer service, math, and organization.Ability to:
prioritize tasks, multitask, and work effectively in a fast-paced environment while maintaining cooperative relationships with staff and patients.Closing Date:
September 27th, 2024
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