Insurance Authorization Specialist Job at Orthopedic Institute, Sioux Falls, SD

bXR3ZEdDa3dtVzNjNys3dVhjNG90RFdMaGc9PQ==
  • Orthopedic Institute
  • Sioux Falls, SD

Job Description

Job Description

We are currently recruiting a full-time Authorization Specialist. A prior authorization specialist assists patients who need treatment requiring insurance carrier pre-authorization. They liaise with insurance companies and nurse managers for prior authorization approval.   This is NOT a remote position.

Orthopedic Institute has been serving the region for over 40 years offering excellent orthopedic care across South Dakota, Western Minnesota, and Western Iowa.

Our history has been marked by partnerships built on shared values and vision. We have recently added physicians to strengthen our position as an independent practice.  We focus solely on exceptional orthopedic care to broaden the reach and impact in this region. Our provider team has grown to include 22 physicians and 20 physician assistants/nurse practitioners and over 230 employees. We currently have locations in Sioux Falls, Brookings, Mitchell and Yankton and numerous outreach locations in the region.

Responsibilities:

  • Verify and document insurance eligibility; confirm and document benefits.
  • Review and submission of clinical documentation to ensure the treatment/services are appropriate for the diagnosis as determined.
  • Obtain and verify that insurance authorizations are obtained and maintained on designated patients.
  • Ensure that initial and all subsequent authorizations are obtained in a timely manner.
  • Work to reduce and eliminate authorization denials.
  • Reviews and interprets pertinent medical record documentation for patient history, diagnosis, and previous treatment plans to pre-authorize insurance plan determined procedures to avoid financial penalties to patient, physician, and facility.
  • Utilizes payor-specific criteria to determine medical necessity for the clinical appropriateness for a broad scope of services and procedures considered effective for the patient's illness, injury, or disease.
  • Obtains appropriate diagnosis, procedure, and additional service codes to support medical necessity of services. 
  • Submits pertinent demographic and supporting clinical data to payor to request approval for services being rendered.
  • Provides referral/pre-notification/authorization services timely to avoid unnecessary delays in treatment and reduce excessive administrative time required of providers.
  • Maintains compliance with departmental quality standards and productivity measures.

Qualifications: 

  • High School diploma or equivalent with four years working experience in a medical environment ( such as a hospital, doctor's office, or ambulatory clinic) OR an associate degree and two years of experience in a medical environment required.
  • Completion of a medical terminology course (or equivalent)  or has 3 years of experience working in the medical field required
  • Baseline knowledge and interpretation of medical terminology and codes
  • Proficient in Microsoft Office applications
  • Excellent communication and interpersonal skills
  • Ability to analyze data and use independent judgment
  • Understanding of authorization processes, insurance regulations, third party payors, and reimbursement practices
  • Experience utilizing an EMR (Electronic Medical Record) or medical office experience required.
  • Orthopedic experience preferred. 
  • Medical terminology, knowledge of insurance processes and customer service required.

Job Tags

Full time, Work experience placement,

Similar Jobs

University of Michigan - Ann Arbor

PATIENT TRANSPORTER | University of Michigan - Ann Arbor Job at University of Michigan - Ann Arbor

 ...Applications received without a resume will not be considered. Transportation staff will arrive at the unit with the transport vehicle (i.e...  ...the Nursing station to retrieve chart and/or card, report to patient room, greet the patient by name, identify the patient by... 

Wyndy

Babysitter Needed for Holiday Party In Dallas, TX Job at Wyndy

 ...hoping to have a fun sitter too! We're looking for someone patient, energetic, and who loves kids! We're a bit quirkywe wear matching Christmas pajamas every year, hence the holiday spirit and we live in Dallas, TX. Pay is $22/hour. We're excited to find someone who can... 

Tekaccel Inc

System Administrator (Deskside Support) Job at Tekaccel Inc

 ...Role: System Administrator (Deskside Support) Location: Kansas City, KS Experience: 6-8 Years Summary: Provide technical support...  ...Directory/Group Policy Scripting (PowerShell, VBScript) Remote support tools ITIL certifications Responsibilities... 

Providence Health & Services

Senior IS Applications Analyst - (Aria/ Eclipse and Mosaiq) *Remote* -AK, CA, WA, OR, MT, NM, TX Only Job at Providence Health & Services

 ...Bachelor's Degree in Computer Science, Business Management, Information Services or equivalent educ/experience ~ Within 90 days of hire Epic certification (must be kept up to date) (Preferred)~4 years Epic Certification with build experience (Preferred)~7 years Build... 

Mayo Clinic

Social Worker - Inpatient Job at Mayo Clinic

 ...future. Responsibilities Provides social work services for facilitating solutions...  ...the direct supervision of a LCSW social worker. This LMSW position will assess data...  ...Schedule Every 4th weekendNo call. International Assignment No Site Description...