Job Summary:

The Authorization-Referrals Specialist II is responsible for verifying insurance policy benefit information, and securing payer required referrals and authorizations. This position is responsible for obtaining accurate and timely pre-authorizations for professional services prior to the patient’s visit, scheduled admission, or immediately following hospital admission. Prior authorizations may include, but are not limited to surgical procedures, outpatient treatments, medications and diagnostic testing (i.e. ultrasounds, labs, radiology, IV therapy, referrals).

Multi-site coverage in the Westchester area may be needed.

Job Responsibilities:

• Verify insurance coverage and update any changes in the billing system.
• Confirm provider’s participation status with patient’s insurance plan/network.
• Determine payer referral and authorization requirements for professional services.
• Contact patient and PCP to secure payer required referral for planned services.
• Initiate authorization and submits clinical documentation as requested.
• Follow through on pre-certifications until final approval is obtained.
• Manage faxes, emails, and phone calls.
• Communicate with surgical coordinators regarding authorizations status or denials.
• Submit appeals in the event of denial of prior authorizations or denial of payment.
• Calculate and document patient out of pocket estimates and provide to patient.
• Serve as primary liaison between faculty practice/department, insurance companies and patient to verify eligibility and coordination of benefits and resolve any insurance complications.
• Assists Supervisor with special projects and/or tasks.
• Assists Authorization-Referrals Specialist I with complex cases or questions.
• Serves as back-up to Authorization-Referrals Specialist III.
• Performs other job duties as assigned.

Job Qualifications:

• High school graduate or GED certificate is required.
• A minimum of 1-year experience in a physician’s billing or third payer environment.
• Candidate must demonstrate the ability to understand and navigate managed care eligibility, insurance billing requirements, and obtaining pre-authorizations.
• Functional proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.)
• Functional proficiency and comprehension of medical terminology.
• Experience in Epic and or other of electronic billing systems is preferred.
• Knowledge of medical terminology, diagnosis and procedure coding is preferred.
• Previous experience in an academic healthcare setting is preferred.

Hourly Rate Ranges: $22.78 - $30.77

Note: Our salary offers will fall within these ranges based on a variety of factors, including but not limited to experience, skill set, training and education.

61st Street Service Corporation

At 61st Street Service Corporation we are committed to providing our client with excellent customer service while maintaining a productive environment for all employees. The Service Corporation offers a competitive comprehensive Benefit package to eligible employees; including Healthcare and various other benefits including Paid Time off to promote a healthy lifestyle.

We are an equal employment opportunity employer and we adhere to all requirements of all applicable federal, state, and local civil rights laws.