Authorization Specialist - Dermatology

📋 Description

• • Obtain prior authorizations for surgical procedures, diagnostic tests, medications, DME, and outgoing referrals as part of daily Revenue Cycle Department operations.
• • Monitor patient schedules, system reports, and dashboards to identify all appointments and procedures requiring authorization.
• • Determine insurance-specific referral and authorization requirements using online resources and established department workflows.
• • Verify patient insurance eligibility and benefits, and update insurance information in the system as needed.
• • Complete prior authorization requests in a timely manner in accordance with department guidelines and carrier protocols.
• • Communicate clearly with patients, physicians, office staff, and managers to resolve issues causing denied or delayed authorizations.
• • Demonstrate comprehensive knowledge of insurance carrier guidelines, clinical policies, and state regulations related to prior authorization.
• • Request, prepare, and recognize necessary documentation to support medical necessity for authorized services, including medical records, dictation, and provider orders.
• • Utilize electronic systems to manage referrals, run reports, document authorizations, move correspondence, resolve eligibility holds, and perform other system tasks within assigned security access.
• • Ensure accurate and complete information is entered into patient accounts to support billing and reimbursement.
• • Collaborate with Reimbursement Department teams to minimize claim denials and ensure proper payment.
• • Work with team members to meet department deadlines, benchmarks, and operational targets.
• • Expertly navigate Epic EHR system to select correct insurance packages and update authorizations and claims accordingly.
• • Sort and prioritize work queues including Inbound Referral Report and Outgoing Referrals to manage daily workload efficiently.
• • Move correspondence from dashboards to appropriate patient accounts within the system.
• • Apply expert knowledge of standard insurance benefit terms, processes, and authorization protocols.
• • Maintain strict patient confidentiality in all interactions and documentation.
• • Investigate authorization denials and initiate appeals with payers and patients as required.
• • Provide immediate feedback to supervisors and managers regarding workflow disruptions, reimbursement issues, or customer service concerns.
• • Use standard office equipment including phone, fax, copy machine, scanner, email, and voicemail to perform job functions.
• • Operate within a Windows-based environment and utilize Microsoft Office Suite for daily tasks.
• • Anticipate and proactively perform necessary job duties to ensure seamless revenue cycle operations.