Insurance Authorization Specialist at Excelsior Orthopaedics in Amherst, New York

Job Description:

Job Summary

Obtains pre-authorizations/pre-certification per payer requirements for services rendered and ensures authorization information is documented in the appropriate system. Your knowledge of insurance carriers and specific plan details will make you a valuable resource to patients, providers, and coworkers! Knowledge of medical codes and medical terminology required.

Duties and Responsibilities

• Obtains pre-authorizations/pre-certification per payer requirements for services rendered and ensures authorization information is documented in the appropriately in the system.


• Verifies physician orders are accurate.


• Ability to understand and communicate insurance co-pays, deductibles, co-insurances, and out of pocket expenses for point of service collections.


• Communication is maintained with providers, clinical staff, and patient in relationship to authorization status.


• Works and assists with the billing department in researching and resolving rejected, incorrectly paid and denied claims as requested.


• Helps to maintain a professional atmosphere for patients, family members and staff.


• Remains current with insurance requirements for pre-authorization and provides education within the departments and clinics on changes.


• Keep management informed of changes in authorization process, insurance policies, billing requirements, rejection or denial codes as they pertain to claim processing and coding.

Requirements and Qualifications

• High school degree or equivalent.


• Knowledge of CPT, HCPCS, and ICD-10 codes highly preferred.


• Medical terminology required.


• Ability to prioritize and perform multiple tasks with many interruptions.


• EMR experience required; MEDENT preferred.

Physical Demands

• Requires prolonged sitting and/or standing; primarily using phone and computer.


• Position requires manual and finger dexterity and hand-eye coordination.


• Involves standing, sitting, and walking.


• Team member will occasionally be asked to lift and carry items weighing up to 10 pounds; normal visual acuity and hearing are required.