Authorization Specialist
Job Overview:
The Authorization Specialist's at Kolmac Integrated Behavioral Health and all its subsidiaries (Kolmac or the Company) main function is to secure prior authorization for our patients from commercial and government payers.
This position serves as the liaison between many other teams and provides excellent customer service to employees, patients, and outside vendors by using their knowledge of how insurance verifications, medical policies, and insurance requirements/guidelines operate.
Essential Duties and
Responsibilities:
Manages daily work queues to ensure prior authorizations are submitted within the company policy and timeline.
Identify and document each payer's policy and procedures regarding coverage and items that require prior approval Identify and document each payer's submission process Submit prior authorizations for approval Follow up with payers to check status of previously submitted prior authorizations Collaborate with care operations, clinical, and partnerships teams to resolve prior authorization denials Enter all documents, client data, new payer data, or responses regarding prior authorization into company systems Be highly responsive and communicate any changes in client's prior authorization status to care operations, clinical, and partnerships teams.
Experience in Behavioral Health (Preferred) Experience in Behavioral Health prior authorization processes (Preferred) Verifies insurance eligibility, benefits, pre-certifications, prior authorizations and referrals requirements for scheduled outpatient services via telephone and/or insurance websites.
Documenting all details in the department's electronic medical record keeping systems accurately including linking all authorizations accurately.
Contact clinicians to obtain clinical documentation that is required by the insurance company.
Validate that the clinical documentation received is what is required by the plan.
Follow up on all pending PA's within 48 hours.
Utilizing the ability to multitask, prioritize and self-motivate to achieve set team and department goals.
Other duties as assigned.
Qualifications - Education and
Experience:
Must Haves:
High School Diploma/ Equivalent preferred.
3
years of experience in the insurance or health care field required.
Experience with Major Medical Insurance.
Knowledge of Pharmacy Benefit Knowledge of Revenue Codes Knowledge of HCPC Codes Knowledge of ICD-10 Codes (Diagnoses Codes) Familiar with the use of a personal computer and other essential office equipment including email software, printer, scanner, copier, fax machine and office telephone required.
Basic insurance and manage care structure knowledge required.
Familiar with hospital electronic medical records systems Effective verbal and written communication skills required The ability to multi-task, prioritize and self-motivate daily.
The ability to walk, sit, lift and stand for extended periods of time PandoLogic.
Category:
Healthcare, Keywords:
Medical Authorization Specialist, Location:
Burtonsville, MD-20866 Recommended Skills Audio Equipments Behavioral Medicine Clinical Works Communication Customer Service Fax Apply to this job.
Think you're the perfect candidate? Apply on company site $('.
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on('click', function (event) window.
ExternalApply = window.
open('/interstitial?jobdid=j3q3hx6rs0mrxltvhtb', 'ExternalApply-j3q3hx6rs0mrxltvhtb'); ); Estimated Salary: $20 to $28 per hour based on qualifications.
The Authorization Specialist's at Kolmac Integrated Behavioral Health and all its subsidiaries (Kolmac or the Company) main function is to secure prior authorization for our patients from commercial and government payers.
This position serves as the liaison between many other teams and provides excellent customer service to employees, patients, and outside vendors by using their knowledge of how insurance verifications, medical policies, and insurance requirements/guidelines operate.
Essential Duties and
Responsibilities:
Manages daily work queues to ensure prior authorizations are submitted within the company policy and timeline.
Identify and document each payer's policy and procedures regarding coverage and items that require prior approval Identify and document each payer's submission process Submit prior authorizations for approval Follow up with payers to check status of previously submitted prior authorizations Collaborate with care operations, clinical, and partnerships teams to resolve prior authorization denials Enter all documents, client data, new payer data, or responses regarding prior authorization into company systems Be highly responsive and communicate any changes in client's prior authorization status to care operations, clinical, and partnerships teams.
Experience in Behavioral Health (Preferred) Experience in Behavioral Health prior authorization processes (Preferred) Verifies insurance eligibility, benefits, pre-certifications, prior authorizations and referrals requirements for scheduled outpatient services via telephone and/or insurance websites.
Documenting all details in the department's electronic medical record keeping systems accurately including linking all authorizations accurately.
Contact clinicians to obtain clinical documentation that is required by the insurance company.
Validate that the clinical documentation received is what is required by the plan.
Follow up on all pending PA's within 48 hours.
Utilizing the ability to multitask, prioritize and self-motivate to achieve set team and department goals.
Other duties as assigned.
Qualifications - Education and
Experience:
Must Haves:
High School Diploma/ Equivalent preferred.
3
years of experience in the insurance or health care field required.
Experience with Major Medical Insurance.
Knowledge of Pharmacy Benefit Knowledge of Revenue Codes Knowledge of HCPC Codes Knowledge of ICD-10 Codes (Diagnoses Codes) Familiar with the use of a personal computer and other essential office equipment including email software, printer, scanner, copier, fax machine and office telephone required.
Basic insurance and manage care structure knowledge required.
Familiar with hospital electronic medical records systems Effective verbal and written communication skills required The ability to multi-task, prioritize and self-motivate daily.
The ability to walk, sit, lift and stand for extended periods of time PandoLogic.
Category:
Healthcare, Keywords:
Medical Authorization Specialist, Location:
Burtonsville, MD-20866 Recommended Skills Audio Equipments Behavioral Medicine Clinical Works Communication Customer Service Fax Apply to this job.
Think you're the perfect candidate? Apply on company site $('.
external-apply-email-saved').
on('click', function (event) window.
ExternalApply = window.
open('/interstitial?jobdid=j3q3hx6rs0mrxltvhtb', 'ExternalApply-j3q3hx6rs0mrxltvhtb'); ); Estimated Salary: $20 to $28 per hour based on qualifications.
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