Authorization Specialist
Lingraphica
- Princeton, NJ
- Permanent
- Full-time
- 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.
- Experience with prior authorizations, pre-determinations, and out-of-network gap exceptions.
- Proficient understanding of healthcare provider environment.
- Excellent problem-solving skills and attention to detail.
- Excellent customer service skills and professionalism.
- Ability to comfortably interface with various users across the organization.
- Proficiency with MS Outlook, Word, Excel, Adobe.
- Knowledge of insurance requirements regarding face-to-face documentation.
- Bachelor's Degree or equivalent combination of education and experience
- Familiarity with entire revenue cycle and terminology.
- Experience with insurance portals such as NaviNet and Availity.
- Experience with DME/Home Medical Equipment.
- Experience with healthcare claims (e.g. authorization, billing, collections).