Authorization Specialist II #Full Time #Remote61st Street Service Corporation • New York, New York, United States
Authorization Specialist II #Full Time #Remote
61st Street Service Corporation
- New York, New York, United States
- New York, New York, United States
Über
ColumbiaDoctors . This position will support ColumbiaDoctors, one of the largest multi-specialty practices in the Northeast. ColumbiaDoctors’ practices comprise an experienced group of more than 2,800 physicians, surgeons, dentists, and nurses, offering more than 240 specialties and subspecialties.
This position is primarily remote; candidates must reside in the Tri-State area (New York, New Jersey, or Connecticut).
Note:
There may be occasional requirements to visit the New York or New Jersey office for training, meetings, and other business needs.
Job Summary:
The Authorization Specialist II is responsible for verifying insurance policy benefit information and securing payer‑required authorizations. This position is responsible for obtaining accurate and timely pre‑authorizations for professional services prior to the patient’s visit, scheduled admission, or immediately following hospital admission. Prior authorizations may include, but are not limited to, surgical procedures, outpatient treatments, medications, and diagnostic testing (i.e., ultrasounds, labs, radiology, IV therapy, referrals).
Job Responsibilities:
Verifies insurance coverage via system tools, payer portals, etc., and updates changes in the billing system.
Confirms provider’s participation status with the patient’s insurance plan/network.
Determines payer referral and authorization requirements for professional services.
Contacts patient and PCP to secure payer‑required referral for planned services.
Documents referral in the practice management system.
Researches system notes to obtain missing or corrected insurance or demographic information.
Reviews clinical documentation to ensure criteria for procedure meet insurance requirements.
Initiates authorization and submits clinical documentation as requested by insurance companies.
Follows through on pre‑certifications until final approval is obtained.
Communicates with surgical coordinators regarding authorization status or denials.
Submits appeals in the event of denial of prior authorizations or denial of payment following procedures.
Sets up peer‑to‑peer calls with clinical providers and insurance companies, as needed.
Calculates and documents patient out‑of‑pocket estimates and provides these to the patient.
Assists Supervisor with special projects and/or tasks.
Assists Authorization‑Referrals Specialist I with complex cases or questions.
Serves as backup to Authorization‑Referrals Specialist III.
Performs other job duties as assigned.
Job Qualifications:
High school graduate or GED certificate is required.
A minimum of 1‑year experience in a physician’s billing or third‑payer environment.
Candidate must demonstrate the ability to understand and navigate managed care eligibility, insurance billing requirements, and obtaining pre‑authorizations.
Candidate must demonstrate strong customer service and patient‑focused orientation and the ability to communicate, adapt, and respond to complex situations, including the ability to diffuse complex situations calmly and professionally.
Must demonstrate effective communication skills both verbally and written.
Ability to multi‑task, prioritize, document, and manage time effectively.
Functional proficiency in computer software skills (e.g., Microsoft Word, Excel, Outlook, email).
Functional proficiency and comprehension of medical terminology.
Experience in Epic and/or other electronic billing systems is preferred.
Knowledge of medical terminology, diagnosis, and procedure coding is preferred.
Previous experience in an academic healthcare setting is preferred.
Hourly Rate Ranges: $23.69 - $32.00
Note: Our salary offers will fall within these ranges based on a variety of factors, including but not limited to experience, skill set, training, and education.
61st Street Service Corporation
At 61st Street Service Corporation we are committed to providing our client with excellent customer service while maintaining a productive environment for all employees. The Service Corporation offers a competitive comprehensive benefit package to eligible employees, including healthcare and various other benefits such as paid time off to promote a healthy lifestyle.
We are an equal employment opportunity employer and we adhere to all requirements of all applicable federal, state, and local civil rights laws.
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Sprachkenntnisse
- English
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