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Job Description :

Your Job:

The Medical Authorization Specialist professional responsible for verification of medical coverage, along with notification, prior authorization, and/or pre-determination of healthcare benefits for proposed medical services, to ensure reimbursement for rendered care. This position routinely works with physicians, clinic support staff, case managers, nurses, insurance utilization management staff, and patients to initiate pre-authorization and resolve issues that arise during the prior authorizations process.  Supports and promotes the vision, mission, and strategic plans of Methodist Health System

Your Job Requirements:

• High School Graduate or equivalent.  Some college preferred
• 1 year of prior clinical and/or insurance experience.
• Knowledge of billing practices and clinic policies and procedures.
• Knowledge of ICD-9, ICD-10 and CPT codes for clinic operating policies.
• Strong proficiency using Microsoft Office products 
• Strong oral and written communication skills 
• Detail oriented, logical, and methodological approach to problem solving 

Your Job Responsibilities:  

• Communicate clearly and openly
• Build relationships to promote a collaborative environment
• Be accountable for your performance
• Always look for ways to improve the patient experience
• Take initiative for your professional growth
• Be engaged and eager to build a winning team
• Ability to interpret Payer Clinical Policies in reference to practice procedures.
• Contacts Payer(s) in a timely manner to obtain, monitor, expedite, and track pre-authorization/pre-certification requests for planned services. Monitors changes in Authorization requests daily, to ensure a faster mode of notification retrieval. 
• Identifies and provides accurate CPT/ ICD codes on the authorization request.
• Maintain appropriate logs or reports according to professional, state and federal requirements
• Refers authorization requests that require clinical judgment to the Provider, and/or Billing Manager, when necessary.
• Advises Manager of all patient complaints, and asks for assistance if problem resolution has not occurred with the patient
• Adheres to patient and office confidentiality guidelines as outlined by the policies and procedures of the office and hospital system as well as HIPPA, red flag regulations, and any other polices that relate to compliance to federal program  guidelines

Methodist Medical Group is the North Texas physician organization affiliated with Methodist Health System. Our fast-growing network of providers includes more than 60 healthcare clinics, an urgent care clinic, and a virtual care service known as MethodistNOW. Our employees enjoy not only competitive salaries but also the outstanding benefits package of Methodist Health System, which includes medical, dental, and vision insurance; a matched retirement plan; an employee wellness program; and more. The opportunities for career growth are equally generous. Our affiliation means being part of an award-winning workplace:

• 150 Top Places to Work in Healthcare by Becker’s Hospital Review, 2023
• Top 10 Military Friendly® Employer, Gold Designation, 2023
• Top 10 Military Spouse Friendly® Employer, 2023