Authorization Specialist

We are searching for an Authorization Specialist – someone who works well in a fast-paced setting. In this position, you’ll be responsible for supporting the pre-admission and admission process, ensuring financial authorization for service is obtained and to providing the authorizing entity with clinical information, including diagnosis and treatment plan, to secure authorization. This role will be primarily responsible for acting as a liaison with the payer representatives, collaboration with providers if medical necessity issues are questioned by payers, and facilitation of communication between providers and payers.

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Job Duties & Responsibilities

• Secures finances to maximize reimbursement in a customer service-oriented fashion
• References the contractual agreements with insurance companies to obtain authorization for services
• Uses communication skills to facilitate non-hospital employee compliance in providing necessary information for authorization
• Provides the highest possible customer service
• Obtains clinical and financial authorization as required by contract for services
• Reviews and acts to secure accounts requiring additional clinical information to extend authorization periods
• Obtains retro-authorizations, if necessary, on accounts in which services have already been provided
• Facilitates provider communication with payer representative and/or payer Medical Director
• Refers any denials of services or cases with questioned medical necessity to the referring physician or his/her designee for additional information
• Verifies authorization requirements with payer representatives and communicates all necessary information to hospital staff
• Provides complete and accurate documentation in EPIC regarding authorizations
• Provides continuous support of process improvements through compilation of data, excellent customer service, monitoring and evaluating departmental roles, and proposals for process improvement initiatives
• Responds to requests from supervisor and customers for authorizations, written or verbal reports (operational, follow-up, financial, etc.) and tasks by the established deadline as observed by supervisor

Skills & Requirements

• 2 years of experience in patient access registration required
• High School Diploma or GED
• Licensed Vocational Nurses certificate is preferred
• National Certified Medical Assistant certificate is preferred
• Emergency Medical Technician certificate is preferred