Authorization Specialist
Authorization Specialist
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$ 21 - 26
1 Vacancy
Job Description
About Our Company
Were a physician-led patient-centric network committed to simplifying health care and bringing a more connected kind of care.
Our primary multispecialty and urgent care providers serve millions of patients in traditional practices patients homes and virtually through VillageMD and our operating companies Village Medical Village Medical at Home Summit Health CityMD and Starling Physicians.
When you join our team you become part of a compassionate community of people who work hard every day to make health care better for are innovating value-based care and leveraging integrated applications population insights and staffing expertise to ensure all patients have access to high-quality connected care services that provide better outcomes at a reduced total cost of care.
Please Note: We will only contact candidates regarding your applications from one of the following domains: @ @ @ @ @ @ or @.
Job Description
The Authorization specialist is responsible for obtaining authorizations for surgical procedures medications DME outgoing referrals and other services as part of the daily operations of the Dermatology Department. Authorization Specialists must have a keen understanding of medical insurance and the clinical policies that determine the authorization protocols for each health plan. Employee will train in office for 6 to 12 months with the option to work from home after training is complete.
Essential Job functions:
Identifies all appointments and procedures for assigned departments that require authorization by monitoring the schedules system reports and dashboards
Identifies the referral and authorization requirements of the patients insurance plans by using various on-line resources according to department workflows
Demonstrates knowledge of insurance carrier guidelines clinical policies and state guidelines pertaining to referrals and prior authorization
Verifies insurance eligibility and benefits and updates the patients insurance information as necessary
Completes referrals and prior authorizations in a timely manner according to department guidelines and workflows
Communicates clearly and effectively with patients physicians office staff and manager to resolve issues that may result in a denied or delayed authorization request.
Demonstrates complete system knowledge ability to run reports document and manage referrals and authorizations move correspondence resolve eligibility and authorization holds and other system tasks within the users security access
Demonstrates the ability to request prepare and recognize the documentation required to support the medical necessity for the service being authorized
Provides the supervisor and manager with immediate feedback on issues affecting workflow reimbursement and customer service.
Ensures that appropriate and accurate information is entered in the patient account
Responds timely and collaborates effectively with the Dermatology Department teams to limit denials and ensure proper reimbursement
Collaborates with team members to meet department deadlines and benchmarks
Demonstrates the ability to use the electronic tools and systems available to organize and process the daily work
Anticipates and performs necessary job duties.
Maintains patient confidentiality
General Job functions:
Expert in selecting the correct insurance package in Athena Collector.
Updates authorizations and claims to reflect the new insurance package.
Expert in sorting work queues and reports to identify and process the daily work (Manage Schedules - Inbound Referral Report - Outgoing Referrals)
Moves correspondence from the dashboard to the patients account.
Expert in generally accepted insurance benefit terms and processes.
Expert in Communication (Case and authorization notation - Physician and Practice location staff Peers - Supervisor/Manager Payers)
Expert in requesting and preparation of supporting documentation such as medical records dictation and orders.
Expert in investigation of authorization denials and appeals (Insurance Patient)
Physical Job Requirements:
Physical agility which includes ability to maneuver body while in place.
Dexterity of hands and fingers.
Endurance (e.g. continuous typing prolonged standing/bending walking).
Environmental Risks:
Allergens: dust mold and/or pollen
Combative Patients / Visitors
Education Certification Computer and Training Requirements:
High School Graduate/GED Required.
Vocational / Technical School / Diploma Program Preferred
2-4 of related experience Preferred
Experience with Standard Office Equipment (Phone Fax Copy Machine Scanner Email/Voice Mail) Preferred.
Experience Standard Office Technology in a Window based environment & Microsoft Office Suite Required.
Pay Range: $21.58 - $26.98 Hourly
The provided compensation range is based on industry standards and salary determinations will be made based on numerous factors including but not limited to years of experience and location of position.
About Our Commitment
Total Rewards at VillageMD
Our team members are essential to our mission to reshape healthcare through the power of connection. VillageMD highly values the critical role that health and wellness play in the lives of our team members and their families. Participation in VillageMDs benefit platform includes Medical Dental Life Disability Vision FSA coverages and a 401k savings plan.
Equal Opportunity Employer
Our Companyprovides equal employment opportunities (EEO) to all employees and applicants for employment without regard to and does not discriminate on the basis of race color religion creed gender/sex sexual orientation gender identity and expression (including transgender status) national origin ancestry citizenship status age disability genetic information marital status pregnancy military status veteran status or any other characteristic protected by applicable federal state and local laws.
Safety Disclaimer
OurCompanycares about the safety of our employees and Companydoes not use chat rooms for job searches or Companywill never request personal information via informal chat platforms or unsecure Companywill never ask for money or an exchange of money banking or other personal information prior to the in-person interview. Be aware of potential scams while job seeking. Interviews are conducted at selectOur Companylocations during regular business hours only. For information on job scams visit file a complaint at Experience:
Unclear Seniority
Employment Type
Full-Time
Key Skills
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