Authorization Referrals Specialist II #Full Time

The 61st Street Service Corporation, provides administrative and clinical support staff for

The Authorization Referrals Specialist II is responsible for verifying insurance policy benefit information and securing payer-required referrals and authorizations. This position is responsible for obtaining accurate and timely pre-authorizations for professional services prior to the patient’s visit, scheduled admission, or immediately following hospital admission. Prior authorizations may include, but are not limited to, surgical procedures, outpatient treatments, medications, diagnostic testing (i.e., ultrasounds, labs, radiology, IV therapy, referrals), and interventional radiology.

• Verify insurance coverage and update any changes in the billing system.
  
• Confirm the provider�s participation status with the patient�s insurance plan/network.
  
• Determine payer referral and authorization requirements for professional services.
  
• Contact the patient and PCP to secure the payer-required referral for planned services.
  
• Initiate authorization and submit clinical documentation as requested.
  
• Follow through on pre-certifications until final approval is obtained.
  
• Manage faxes, emails, and phone calls.
  
• Communicate with surgical coordinators regarding authorization status or denials.
  
• Submit appeals in the event of denial of prior authorizations or denial of payment.
  
• Calculate and document patient out-of-pocket estimates and provide them to the patient.
  
• Serve as primary liaison between faculty practice/department, insurance companies, and patients to verify eligibility and coordination of benefits and resolve any insurance complications.
  
• Assists the Supervisor with special projects and/or tasks.
  
• Assists the Authorization-Referrals Specialist I with complex cases or questions.
  
• Serves as back-up to Authorization-Referrals Specialist III.
  
• Performs other job duties as assigned.
  

• A high school graduate or a GED certificate is required.
  
• A minimum of 1 year of experience in a physician�s billing or third-party environment.
  
• Candidate must demonstrate the ability to understand and navigate managed care eligibility, insurance billing requirements, and obtain pre-authorizations.
  
• Functional proficiency in computer software skills (e.g., Microsoft Word, Excel, and Outlook, Email, etc.)
  
• Functional proficiency and comprehension of medical terminology.
  
• Experience in Epic and or other electronic billing systems is preferred.
  
• Knowledge of medical terminology, diagnosis, and procedure coding is preferred.
  
• Previous experience in an academic healthcare setting is preferred.
  

Note: Our salary offers will fall within these ranges based on a variety of factors, including but not limited to experience, skill set, training and education.

At 61st Street Service Corporation, we are committed to providing our clients with excellent customer service while maintaining a productive environment for all employees. The Service Corporation offers a competitive, comprehensive Benefit package to eligible employees, including Healthcare and various other benefits, such as paid time off, to promote a healthy lifestyle.

We are an equal employment opportunity employer, and we adhere to all requirements of all applicable federal, state, and local civil rights laws.