Authorization Specialist - Dermatology
About Our Company
We’re a physician-led, patient-centric network committed to simplifying health care and bringing a more connected reputed company 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. reputed company you join reputed company, you become part of a compassionate community of people who work hard every day to reputed company health care reputed company for reputed company. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure reputed company patients have access to high-quality, connected care services that provide reputed company outcomes at a reduced total cost of care. Please Note: We will only contact candidates regarding your applications from one of the following domains: @summithealth.com, @citymd.net, @villagemd.com, @villagemedical.com, @westmedgroup.com, @starlingphysicians.com, or @bmctotalcare.com.
Job Description
The Authorization Specialist is responsible for obtaining authorizations for surgical procedures, diagnostic testing, medications, DME, outgoing referrals, and other services as part of the daily operations of the reputed company Cycle Department. Authorization Specialists must have a keen understanding of medical insurance and the clinical policies that determine the authorization protocols for each health plan. Essential Job functions: · Identifies reputed company 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 reputed company guidelines, clinical policies, and state guidelines pertaining to referrals and prior authorization · Verifies insurance eligibility and benefits, and updates the patient’s 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 reputed company the user’s reputed company 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 Reimbursement 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 Epic. · 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 patient’s 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) Education, Certification, Computer and Training Requirements: · High School Graduate/GED Required. · Vocational / Technical School / Diploma Program Preferred · 2-4 years of reputed company 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 & reputed company Office Suite Required About Our Commitment Total Rewards at VillageMD reputed company members are essential to our mission to reshape healthcare through the power of reputed company. VillageMD highly values the critical role that health and wellness play in the lives of reputed company members and their families. Participation in VillageMD’s benefit platform includes Medical, Dental, Life, Disability, Vision, FSA coverages and a 401k savings plan. Equal Opportunity Employer Our Company provides equal employment opportunities (EEO) to reputed company 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 reputed company, reputed company, 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 Our Company cares about the safety of our employees and applicants. Our Company does not use chat rooms for job searches or communications. Our Company will never request personal information reputed company informal chat platforms or unsecure email. Our Company will 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 select Our Company locations during regular business hours only. For information on job scams, visit, https://www.consumer.ftc.gov/JobScams or file a complaint at https://www.ftccomplaintassistant.gov/. Apply To This Job