Authorization Document Specialist - Full-time / Part-time

Authorization Document Specialist

SUMMARY

Create and generate electronic forms requesting patient documents from physicians and insurances, as well as collect and manage patient eligibility documents.

DUTIES AND RESPONSIBILITIES

• Create and generate electronic forms requesting patient documents from physicians.
• Collect and manage patient eligibility documents such as prescriptions, certificates of medical necessity, letters of medical necessity and prior authorizations.

• Contact doctor offices as necessary to collect prescriptions, certificates of medical necessity, letters of medical necessity, clinical notes and lab results.
• Contact insurance companies to collect approved prior-authorization requests.
• Escalate recurring problem accounts or physician groups or other trends to the management appropriately and in a timely manner.
• Due to access to sensitive information, maintain a high degree of confidentiality at all times.
• Maintain regular, predictable, consistent attendance and flexibility to meet the needs of the department.
• Understand and follow all Medicare, Medicaid, HIPAA, and Private Insurance regulations and requirements.
• Plan and organize work effectively and ensure its completion.
• Meet all productivity requirements.
• Demonstrate team behavior and promote a team-oriented environment.
• Actively participate in continuous quality improvement.
• Represent the organization professionally at all times.
• Serve as backup to Customer Service department for customer concerns, issues, complaints, or questions.
• All other duties and responsibilities that may be assigned.

QUALIFICATION REQUIREMENTS

To perform this job successfully, an individual must be able to perform each of the above essential duties satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

LANGUAGE SKILLS

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

MATHEMATICAL SKILLS

Ability to calculate figures and amounts such as discounts, copays and co-insurance percentages.

REASONING ABILITY

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.

Ability to deal with problems involving several concrete variables in standardized situations.

OTHER SKILLS and ABILITIES

Ability to plan and multi-task; excellent communication skills; detail oriented; skilled and accurate in date entry. Knowledge in Pharmacy Software, and use of the internet and email programs.

High School diploma/equivalent

1-3 years of relevant experience, 2-5 years preferred

This is a temp to hire opportunity, $12.50 - $14.00 per hour DOE