The purpose of the Authorization Specialist position is to be responsible for all aspects of the prior authorization process. Responsibilities include collecting all the necessary documentation, contacting the client for additional information and completion of authorization (both private clinic and hospital clinics). Complete, timely, and accurate identification and submission of prior and retro authorization requests to the payors. Interacts with clients, insurance companies, patients, and sales representatives, as necessary, to request for prior authorizations. Responsible for documenting account activity, updating patient and claim information within assigned EMR system. Ensure all functionalities are utilized for the most efficient processing of claims and identifies prior authorization trends and/or issues resulting in delayed claims processing. Provides the highest level of customer service to internal and external clients. This position requires simple computer data entry and use of Microsoft Office Products

ESSENTIAL FUNCTIONS

• Obtains necessary information to submit authorizations for new and continue of care patient needs.
• Communicates and works effectively with colleagues from other departments
• Become proficient in the use of ICD-10 and CPT codes
• Understand Payor expectations for billing, reimbursement, credentialing, audit
• Identify and report trends and prior authorization issues relating to billing and reimbursement
• Reviews accounts daily while meeting or exceeding all daily, weekly, and monthly production goals
• Document all account activity and correspond to inquires in a timely manner
• Proactively manages and maintains all outstanding authorization accounts to increase billing of clean claims
• Research patient accounts due to invalid and/or missing authorization information and correspond with clients,
• insurance companies, patients, sales representatives to obtain the necessary information to ensure accurate, timely
• and complete claims submission
• Prepares daily productivity report and submits it to Authorization Supervisor
• Performs additional duties deemed necessary to the position and its function

DESIRED SKILLS & ABILITIES 

• Ability to type 60 words per minute preferred.
• Strong interpersonal, oral (includes telephone skills) and written communication skills.
• Good organizational skills and an ability to prioritize to meet deadlines.
• Complete understanding of medical reimbursement and terminology.
• Ability to work with disabled individuals.
• Working knowledge of all standard office equipment.
• Working Knowledge of insurance and outpatient billing procedures.
• High School Diploma with courses in bookkeeping and accounting OR an equivalent amount of work experience in a healthcare or related setting
• One to two years of medical billing and administrative experience
• One year of supervisor experience.

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Expanding Access to Quality Care

At PT Solutions, we’re more than colleagues; we’re a tight-knit community united in our mission to expand access to quality care. Our commitment to you is evident in our industry-leading professional development opportunities. From ongoing evidence-based clinical education to dedicated mentorship opportunities and an APTA-accredited Orthopaedic Residency Program, we propel our clinicians toward excellence in physical therapy, occupational therapy, speech-language pathology, and athletic training.

As we aim to be the go-to rehabilitation provider, we seek committed professionals eager to join us in that mission. A career with PT Solutions is an opportunity to shape the industry and make a lasting impact. 

Let’s go further together and transform care. Join the #PTSLife today! 

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