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Authorization Specialist

UConn Health - Community Network
Waterbury, USA
Full-time
Mid
Onsite
Discovered 1 weeks ago

Full Job Posting

Qualifications

  • Required:
  • High school diploma or equivalent.
  • Experience in medical office administration, procedure scheduling, insurance verification, or prior authorizations.
  • Working knowledge of medical terminology and health insurance processes.
  • Strong organizational skills with excellent attention to detail.
  • Ability to manage multiple tasks, meet deadlines, and prioritize effectively.
  • Excellent communication and customer service skills.
  • Proficiency with electronic medical records and standard computer applications.
  • Preferred:
  • Previous experience in a cardiology practice or cardiovascular service line.
  • Experience obtaining authorizations for diagnostic imaging, cardiac testing, and invasive procedures.
  • Familiarity with CPT and ICD-10 coding.
  • Knowledge of commercial insurance, Medicare, Medicaid, and managed care authorization requirements.
  • Experience coordinating procedures with hospital scheduling departments.
  • Key Competencies
  • Strong attention to detail and accuracy
  • Effective time management and follow-through
  • Ability to work independently and collaboratively
  • Strong problem-solving and critical-thinking skills
  • Professional and compassionate patient communication
  • Ability to adapt to changing priorities in a busy clinical environment

Responsibilities

  • Essential Duties and Responsibilities
  • Obtain and manage insurance prior authorizations for invasive and non-invasive cardiac procedures, including cardiac catheterizations, electrophysiology procedures, vascular studies, cardiac CT, and other diagnostic or interventional services.
  • Coordinate procedure scheduling with hospitals, outpatient facilities, physicians, and patients.
  • Submit authorization requests with appropriate clinical documentation and follow up with insurance carriers to ensure timely approvals.
  • Track pending authorizations, identify potential delays, and communicate issues to the appropriate clinical staff.
  • Assist with denied authorizations, appeals, and peer-to-peer review coordination as needed.
  • Ensure accuracy of procedure orders, diagnosis codes, CPT codes, and supporting documentation.
  • Communicate procedure dates, times, preparation instructions, and other relevant information to patients.
  • Maintain accurate and timely documentation of authorizations and scheduled procedures within the electronic medical record.
  • Collaborate with physicians, clinical teams, and administrative staff to resolve scheduling conflicts and authorization issues.
  • Monitor upcoming procedures to ensure all necessary authorizations and scheduling requirements are completed prior to the date of service.
  • Maintain patient confidentiality and comply with HIPAA regulations.
  • Perform other related duties as assigned.

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