Authorization Specialist

Job Summary

• Coordinates precertification/authorization services for patients across the continuum of care, promoting quality care, and effective utilization of resources.
• Provides leadership when dealing with patient preauthorization functions, including inpatient and outpatient services.
• Coordinates efforts between departments to ensure accurate precertification, resulting in timely billing of claims.
• Some overtime and call back may be required.
• Performs other duties as assigned.

Responsibilities

• Precertifies patient care services that require precertification, in a timely, efficient manner, in order to optimize reimbursement for the patient as well as health care providers.
• Communicates recommendations, clinical information, and fiscal information to appropriate internal and external customers in order to facilitate optimal delivery of services and customer satisfaction.
• Reviews orders for accuracy and medical necessity to facilitate delivery of services and appropriate reimbursement.
• Addresses issues identified with retrospective reviews for all payers.
• All outpatient procedures will be timely precerted when applicable.
• Works to improve the QI/PI process.
• Assumes responsibility for personal growth and development by attendance and / or participation in inservices and continuing education programs.
• Completes assigned goals.

Specifications

Experience

• Minimum Required
• 2 years of office and/or clinical experience.

• Preferred/Desired
• Prefer experience in a clinic setting as well as dealing with prior authorizations.

Education

• Minimum Required
• Knowledge of medical terminology

• Preferred/Desired
• Associates degree in related field

Training

Minimum Required

Preferred/Desired

Special Skills

• Minimum Required
• Advanced communication, conflict management, organizational and planning skills; advanced computer literacy skills.

Preferred/Desired

• Licensure
• LPN license

Minimum Required

• Preferred/Desired
• LPN