STLC Medical Authorization Specialist

Job Title : Medical Authorization Specialist

Supervisor : Director of Finance

FLSA Status : Non-Exempt

Salary Range: See Salary Scale

Job Summary : Under the direction of the Director of Finance, the Medical Authorization Specialist will e nsure that all claims have the required documentation for claims adjudication for timely payment.

Specifications

Education : Minimum High School Diploma, Associates Degree Preferred.

Experience : Minimum one year of employment in a medical office setting, or equivalent business office experience.

Number and Type of Employees Supervised (optional) : None

Licensure, Registry or Certification Required : NC driver’s license, maintains minimum automobile liability insurance for durations of employment.

Special Training : Must be able to work effectively in a team environment. Must possess excellent communication, interpersonal skills. Proficient in Excel and Word. Be knowledgeable in multiline computer operations as well as excellent writing and reporting skills.

Immunizations: Be medically cleared for communicable diseases and have all immunizations up to date before engaging in direct participant contact.

Ages Of Patients Rendered Care

Adult Geriatric

Key Responsibilities: (*denotes an age-related skill or task)

• Ensures authorizations are created in electronic claims system for claims adjudication.
• Researches and Coordinates with Scheduler for missing authorization documentation.
• Provides quick and accurate retrieval of information as needed by the interdisciplinary team (IDT) as it relates to the Pend Report.
• Reports missing medical records to Health Information Management Clerk for requesting notes from providers.
• Coordinates, collaborates, and communicates with the Contract Management Liaison as it relates to participants’ appointments with non-contracted providers.
• Answers accounting and financial questions by researching and interpreting data. Handles and resolves claims inquiry as requested.
• Ensures all Provider & Vendor electronic & paper claims are processed within 45 days. Updates and maintains report for claims > 90 days. Reviews Claims Inventory Report weekly to ensure claims are processed timely.
• Backup to the Business Office Specialist and other duties as assigned.
  
  

Knowledge, Skills, And Abilities

• Must be capable of performing job responsibilities.
• Ability to work effectively in a team environment.
• Excellent verbal and written communication skills.
• Ability to write and present information clearly.
• Proficient computer skills with MS Office products, knowledge of excel formulas.
• Excellent customer service and communication skills.
• Consistently demonstrates responsibility, accountability, and dependability.
• Maintains current, unrestricted driver’s license.