Pre-Authorization Specialist Job Description (Hybrid role):

• Obtain pre-authorizations for gastro procedures (colonoscopy, endoscopy, ERCP, capsules, etc.) – they will need to understand CPT and ICD codes.
• Must have a comprehensive knowledge of insurance carrier policies and procedures – insurance will often provide incorrect/misinformation (such as no authorization required). They must have the knowledge to push back and question what they’re told.
• Our company policy is they must be two weeks ahead of the scheduled procedures as authorization requests can be delayed/take longer than expected – this requires speed.
• Eligibility verification for all patients being seen each day using various portals – our EMR (ECW), Navinet, Availity, E-tactics, etc.
• We are a very busy practice – they need to have an element of speed to keep up with the eligibility and authorization requests.
• The ability to comprehend and explain patient benefits – deductibles, coinsurance, copays, any patient responsibility.
• They will be calling patients to explain these benefits prior to their procedures – they need to have an element of customer service and be able to explain and answer questions regarding patient benefits/financial responsibility.
• The ability to effectively communicate with providers, staff, and patients – both written and oral. They will be sending many emails to providers and staff regarding authorization requests, they are also communicating with patients regularly. They will be a representation to both our doctors and patients and must present themselves professionally.