Authorization/Eligibility Specialist Job – NY, East Setauket

city: Setauket

JOB TITLE: Authorization/Referral Specialist


SB Administrative Services provides management services for the practices of Stony Brook Community Medical, PC. Our network of community-based physicians work closely with the physicians at Stony Brook Medicine, Stony Brook University Hospital, Affiliated community hospitals and with other medical professionals to enhance the coordination of the medical care for every patient in the communities we serve.


The Authorization/Eligibility specialist works within the Centralized Business Office, as a liaison between the physicians and the patient. The position interfaces with physicians, patients, and administrative personnel and answers phone calls, responds to fax and email communication and routes messages accordingly. The focus of the position is to obtain prior authorizations for medications and/or procedures. To review patient insurance eligibility and process authorizations to ensure approvals are on file for each patient scheduled to receive services at the Practice. Duties include reviewing insurance information, requesting authorization from insurance carriers, and data entry.



  • Generates report from the Practice Management (PM) system to review the patients and services scheduled for the next business day
  • Reviews patient insurance information to verify eligibility for scheduled services such as appointments, testing, and surgery
  • Prints and/or saves eligibility forms for the front desk receptionists at assigned location the day before the appointment date
  • Prepares and requests authorization for scheduled appointments and surgeries prior to the appointment/surgery date
  • Processes any referral authorizations and sends referral requests to referring physician's offices, if needed
  • Reviews all authorizations processed by the Front Desk Receptionists to ensure accuracy and completeness ? fixes issues, if any
  • Inputs patient demographics and insurance information into the PM system
  • Troubleshoots any issues with patient eligibility and authorizations by contacting the insurance companies
  • Receives any complex eligibility/authorization issues or questions and processes them accordingly
  • Cancels or reschedules patients based on insurance information, as needed
  • Provides coverage for front desk personnel, as needed
  • Performs various administrative duties such as answering phones, directing calls or messages, accurately entering data into the patient medical records, and transporting files/materials between offices
  • Works overtime as necessary
  • Follows applicable policies and procedures and takes precautions to establish a safe work environment
  • Maintains strict patient protocols in accordance with practice policies/ HIPAA requirements
  • Maintains a high level of professionalism with patients and works to establish a positive rapport
  • Performs other duties as assigned
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