The Authorization and Benefits Specialist is responsible for obtaining benefits and preauthorization from payors, following up on authorization requests, obtaining retroactive authorizations, and maintaining authorizations for new patients.JOB-SPECIFIC FUNCTIONS:Responsibilities include initiating, following up, and securing benefits and authorizations sent to third-party payors. Obtain authorization renewalsTrack and follow up on all pending authorizations at 3, 7,14, 30 days depending upon payer guidelines to expedite the claims process and avoid lost revenueProcess authorizations electronically, utilizing payer portals, fax, or telephone working with the payers to secure authorizations retrospectively and/or requesting single case agreements for out of network patientsWork directly with providers to secure clinical notes and other supporting documentation required to obtain authorizations timelyVerify authorization quantities and effective dates are returned and processed correctly by the third-party payers, and loaded correctly in all systemsCreate and maintain centralized payer master list to record requirements by payerCreate a payer authorization manual and tips to securing authorizationIdentify opportunities to improve authorization efficiencies electronicallyReview and interpret insurance group pre-certification requirements, ensuring that proper pre-authorizations have been obtained from the payer and documented.Interact with patients and third-party insurance companies to secure retroactive insurance coverage and authorizations, and/or single case agreements for out of network patients
