Medical Authorization/Appeals Specialist
Randstad Non-Clinical Healthcare is seeking professional Authorization/Appeals Specialist. You will have the opportunity to work in a friendly and caring work environment. If you are looking for a position in a dynamic, fast-paced organization with career growth opportunities, come grow with us!
ABOUT THE POSITION
Title: Authorization/Appeals Specialist
Monday through Friday, 8:00am to 5:00pm
Temp to Hire
Location: Frisco, TX 75034
--Review medical records and prepare authorizations.
--Review denials and medical records and prepare appeals.
--Follow up on all pending authorizations and appeals until resolution.
--Analyze medical documentation and apply criteria to determine medical necessity, acuity of care, severity of illness and intensity of service.
--Check third-party payer eligibility to ensure that the information provided matches the database information.
--Communicate authorization and appeal status to assigned facilities and onsite staff.
--Submit and/or mail the retro-authorization form and supporting documentation to payer program.
--Update accounts based on balance and update systems as work is completed.
--Prepare daily, weekly and monthly reports for facilities and other departments.
--Communicate issues and project status to management.
--Follow suspense dates in internal system to update account status on the authorizations or appeals on a timely basis.
--Handle and manage multiple tasks and duties; organize and prioritize workload in a timely manner.
Working hours: 8:00 AM - 5:00 PM
--Working knowledge of Medical Terminology
--At least 1 year of experience with CPT, DRG and ICD-9/10 codes
--At least 2 years of filing retrospective, concurrent or prior authorizations is required
--Must have excellent follow through skills during the application process
--Must demonstrate the ability to multi-task job responsibilities and remain focused on these duties for long periods of time
--Must possess strong written and verbal skills
--Consistent punctuality and attendance is required
--High School Diploma/GED or equivalent
Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad. EEO Employer: Race, Religion, Color, National Origin, Citizenship, Sex, Sexual Orientation, Gender Identity, Age, Disability, Ancestry, Veteran Status, Genetic Information, Service in the Uniformed Services or any other classification protected by law.