Medical Authorizations Specialist (Pathology & Diagnostic Testing)
Posted on Indeed on Mar 31, 2021

Medical Authorizations Specialist (Pathology & Diagnostic Testing)

University of Colorado Medicine, 13199 E MONTVIEW BLVD, AURORA, Colorado, United States of America Virtual Req #481

Friday, March 19, 2021

CU Medicine is dedicated to providing healthcare and administrative support to the University Of Colorado School Of Medicine’s nearly 3,000 providers.
We are seeking a highly motivated Authorization Specialist to support the Department of Pathology as part of our Accounts Receivable Resolution team.

Candidates residing outside the state of Colorado will be considered for 100% remote work.

The Authorization Specialist is responsible for obtaining pre-certifications and pre-authorizations for referred solid tumor and other specific cancer gene and mutational testing and analysis. Additionally, the individual in this position will work as part of a team aimed at resolving denied claims resulting from incomplete or missing pre-authorizations.
The Authorization Specialist will:
  • Contact insurance carriers to verify patient’s insurance eligibility, benefits and requirements.
  • Request, follow up and secure prior-authorizations from insurance carriers prior to services being performed.
  • Demonstrate and apply knowledge of medical terminology in combination with a high proficiency of general medical office procedures including HIPAA regulations.
  • Maintain expert knowledge of insurance payment policies relative to molecular testing and personalized medicine in an effort to minimize denials due to authorizations, frequency, or medical necessity
  • Maintain productivity levels aligned with department benchmarks.
  • Document all communications and contacts with providers and personnel in standardized formats.
  • Obtain information to complete referral and authorization related rejections and process in a timely manner which may include initiating communication via phone, email, website, and/or letters to coding staff, clinics, facilities, and insurance companies to obtain necessary information.
  • Review and resolve all invoices rejected due to referral/authorization related rejection codes through assigned workfiles and other tools which requires the retrieval, review and understanding of medical records.
  • Perform account research and provide updates as necessary to support the referral process.
  • Identify trends and patterns of referral/authorization rejections by payer, provider, clinic, and other metrics and report these trends to team and management as appropriate.
  • Participate in Team Meetings and educational in-services as required.
  • Work with management to document and maintain policies and procedures for assigned areas of responsibility.
  • Assist in the education and training of new staff as needed.
  • Provide cross coverage to ensure timeliness and quality of the overall ARR appeal processes.
  • Perform other duties and assist with special projects as assigned.
Requires a minimum of 3 years’ experience in medical practice billing with exposure to working with authorizations, denials, appeals, insurance collections and related follow-up; bachelor’s degree in a related field is strongly preferred. Must have ICD-10 and CPT coding assessment skills, CPC certification is a plus. Intermediate PC software experience required. Advanced verbal and written communication skills are essential to success. Must demonstrate a solid understanding and ability to apply contract language to billing. Proven ability in collections and negotiation desired.
All applications MUST be submitted via our website.
CU Medicine is dedicated to ensuring a safe and secure environment for our staff and visitors. To assist in achieving that goal, we conduct background investigations for all prospective employees prior to their employment. We are an equal opportunity employer.

The listed pay range (or hiring rate) represents CU Medicine’s good faith and reasonable estimate of the range of possible compensation at the time of posting and is based on evaluation of competitive market data.

A variety of factors, including but not limited to, internal equity, experience, and education will be considered when determining the final offer.

CU Medicine provides generous leave, health plans and retirement contributions which take your total compensation beyond the number on your paycheck. Find information about our benefits here

CU Medicine supports a Tobacco Free Workplace Environment which prohibits smoking and the use of tobacco products on CU Medicine property, Anschutz Medical Campus and adjacent business locations

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