Medical Authorization Specialist

At Rooted Life, we're seeking a Medical Authorization Specialist to join our team. As a Medical Authorization Specialist, you will play a critical role in ensuring that patients receive the necessary authorization for their medical treatments. This is an exciting opportunity to work with a compassionate and innovative organization dedicated to aiding those experiencing homelessness, recovering from hospital stays, or facing housing challenges.

The Role

We're looking for a highly organized and detail-oriented individual with extensive experience in insurance verification, prior-authorization, and team coordination. As a Medical Authorization Specialist, you will be responsible for ensuring a patient's visit is financially secured. This role requires proficient communication and the ability to handle insurance verification, notification, and authorization, as well as communicating patient financial responsibilities and other patient access operational activities.

Responsibilities

• Data Accuracy: Collects and reviews patient demographic and insurance data as part of the authorization process.
• Documentation Management: Collects and submits all necessary documentation and diagnoses needed for authorizations.
• Follow-Up Expert: Provides daily updates on the status of authorization requests to ensure optimum service delivery.
• Reimbursement Maximiser: Focused on ensuring maximum reimbursement through meticulous billing and coding for all services rendered.
• Claims Specialist: Manages the full claims process in our EHR, from creation to follow-up, handling insurance inquiries with expertise.
• HIPAA Guardian: Upholds the strictest confidentiality and adheres to all HIPAA regulations.
• Insurance Liaison: Confirms and documents the patient's health insurance details, including effective dates, network status, and coverage requirements.
• Problem Solver: Utilizes problem-solving skills to address any issues arising from insurance coverage or prior authorizations.
• Knowledge Maintainer: Keeps updated with contract limitations and details for each Managed Care Plan (MCP) and stays informed about the services and programs offered by Rooted Life.

Ideal Candidate

• At least 5 years of experience within a Medical Authorization and/or Medical Billing role in the Healthcare industry.
• Working knowledge of Medical Billing, Revenue Cycle Management (RCM) and Insurance Authorizations.
• Strong analytical skills and comfortable dealing with numerical data.
• Highly goal-driven and able to work well in fast-paced environments.
• Pays strong attention to detail and delivers work of a high standard.
• Knowledge of insurance verification, prior-authorization, and office coordination.