The Authorization Specialist works with payers and SEARHC clinical staff to obtain initial and ongoing authorizations for patient services, verifies insurance benefits for each patient, and authorizations for patients in accordance with the payer-provider contracts. The Authorization Specialist is responsible for tracking and correcting all pertinent insurance information in the electronic medical record. They are expected to maintain strong working relationships with payers, SEARHC billing staff, and all other interdepartmental staff, and provide excellent customer service at all times.

$22.17-$26.55, DOE

• Knows, understands, incorporates, and demonstrates the Mission, Core Values, and Vision in behaviors, practices, policies, and decisions.
• Maintains collaborative, team relationships with peers and colleagues to contribute to the working group’s achievement of goals effectively, and to help foster a positive work environment.
• Protects confidentiality/privacy in verbal, written, and electronic forms of communication or information sharing.
• Raises concerns in appropriate manner and according to policy.
• Consistently exhibits behavior and communication skills that demonstrate SEARHC’s commitment to superior customer service, including quality, care, and concern with each and every internal and external customer.
• Accurately captures and records inbound and outbound authorizations for patients and/or referring physician’s offices.
• Carries out due diligence to obtains authorizations from various insurance carriers via phone, in writing or email.
• Processes authorization-related denials and coordinates the appeal process with the appropriate Revenue Cycle staff members.
• Ensures efficient documentation of information for insurance verification, registration and billing requirements and follows-up as needed.
• Responds to inquiries regarding status of authorization(s) by assessing the request and evaluating the circumstances to provide the needed information.
• Demonstrates superior customer service to all external and internal customers.
• Communicates effectively with patients, physicians, and/or other departments regarding delay or issues relating to authorizations and patient appointments.
• Meets team metric standards and expectations consistently.
• Maintains strict confidentiality at all times.
• Identifies compliance/ethics issues and bring forth recommendations for operational improvement.
• Ensures successful adherence to policies, procedures and changes to the organization.
• Complete and support additional patient access related activities as assigned.
• Other duties as required and assigned by the supervisor

Education:

High School Diploma or GED

Experience:

Entry level position with on the job training provided

Knowledge, Skill, and Ability:

Knowledge of:

• Medical Terminology or CPT or procedure codes; alternatively, contains the willingness to learn
• General office functions, office equipment, and computer applications

Skills in:

• Working independently
• Good interpersonal, verbal, and written communication
• Strong attention to detail

Ability to:

• Prioritize work in multi-task in a fast-paced office setting with many interruptions
• Self-start and willingness to learn
• Read and comprehend simple instructions, short correspondence, and memos
• Demonstrate time-management, organizational, and customer service skills
• Work flexible hours with limited unplanned absence
• Problem-solve
• Effectively prioritize multiple ongoing tasks and responsibilities under pressure at a steady pace in an unpredictable environment
• Handle difficult customer situations in a positive manner
• Interact with external healthcare professionals in a variety of settings