Authorization Specialist

Job Summary: The Authorization Specialist coordinates, processes and documents medical referrals and prior authorizations for a variety of medical services for clinic patients. This requires clinical knowledge and understanding of CPT and ICD-10 codes to meet the requirements of third party payers and specialty clinics to ensure minimal delay in securing referral appointments or pre-authorizations. The Referral Specialist manages a high volume of referrals and pre-authorizations for multiple Providers and collaborates with other Clinic Referral Specialists, Providers, MA's, Front Coordinator(s) and other support staff in multiple clinic locations. This position requires the use of clinical and administrative judgment and initiative to determine best approach for both urgent and non-urgent patient care needs.
Job Functions: Completes all required documentation accurately, in a timely manner, and thoroughly in accordance with department standards; in addition, documentation complies with patients' insurance requirements. Per referral guidelines, provide appropriate clinical information to specialist. Perform eligibility determination for clinic patients. Performs other duties as assigned. Prepares and processes all referral and pre-authorization paperwork, including gatherings pertinent information as needed via EHR, from incoming phone/email/fax messages, or from clinical team. Contacts various clinics, facilities, and companies to obtain information to accurately complete referral/pre-authorization requests.
Skills: Ability to maintain good interpersonal interactions with clients and co-workers as a member of the team with a diverse multi-cultural population. Ability to multi-task, be flexible, ensure accuracy, and meet changing priorities in a fast-paced, high-workload environment. Basic computer literacy (i.e., use system to manage and schedule appointments, access electronic medical record information). Basic organizational skills, attention to detail, time-management skills, and strong motivation to meet deadlines and achieve goals. Clinical knowledge of medical terminology, medical procedures, CPT, and ICD-9 (10). Intermediate knowledge of insurance providers, their portals and their expectations for authorization approval.
Education: High school diploma or GED equivalent required.
Requirements: Must be bilingual in English and Spanish.
Compensation: Dependent on qualifications and experience.
Benefits: Health, Dental, Vision, FSA and EAP benefits.
Location: Primary office in Chula Vista, CA