Authorization Specialist

Job Description
Purpose:
The Authorization Specialist’s main function is to secure funding approvals for our customers whether it be from private insurances, State funding, Medicare, or any other type of funding source. This position serves as the liaison between many other teams and provides excellent customer service to employees as well as customers using their knowledge of how insurance verifications, medical policies, and insurance requirements/guidelines work. The Authorization Specialist is also responsible for maintaining accurate records of policies and insurances for employees to view and reference as needed.
Essential Duties &
Responsibilities:
Initiates prior authorizations, pre-determinations, and out-of-network gap exceptions.
Initiates and follows through with authorization appeals.
Follows up on all authorization requests in a timely manner and reports on progress to internal teams.
Applies to and follows up on applications for funding through Government programs.
Negotiates and obtains agreements with insurance companies for individual cases when necessary.
Communicates internally and externally regarding authorizations, appeals, and exceptions.
Assists in eligibility and benefits inquiries when necessary.
Determines the authorization requirements of each health plan and keeps detailed records of the medical policies and requirements.
Maintains accurate and complete documentation of all inquiries.
Proactively communicates with team members regarding identified potential issues and concerns.
Tracks patterns and trends of authorization issues from payers to eliminate future delays in authorization processing.
Exhibits strong problem-solving skills through both verbal and written communications.
Assists reimbursement team in authorization related corrections on rejected or denied claims.
Answers in-bound calls and assists customers.
Exercises the above with discretion and independent judgement.
Performs other duties and works on special projects related to authorization.