Authorization Specialist II

Job Description:

• Works with payers and SEARHC clinical staff to obtain initial and ongoing authorizations for patient services
• Verifies insurance benefits for each patient
• Obtain authorizations for patients in accordance with the payer-provider contracts
• Responsible for tracking and correcting all pertinent insurance information in the electronic medical record
• Maintain strong working relationships with payers, SEARHC billing staff, and all other interdepartmental staff
• Provide excellent customer service
• Critical for reimbursement of costs relating to high dollar procedures and services provided to our patients
• Accurately captures and records inbound and outbound authorizations for patients and/or referring physician’s offices
• Carries out due diligence to obtain 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 and clinical team
• Work closely with the Financial Counselors and Patient Access team to ensure coverage is current and documented appropriately in the record
• Ensure 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
• Communicates effectively with patients, physicians, and/or other departments regarding delays 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 brings 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

Requirements:

• High School Diploma or equivalent – required
• CHAA Certification within 6 months of hire
• Two years of experience as an Authorization Specialist - preferred
• Two years of working in a healthcare, office, or customer service setting may be substituted
• Knowledge of Understanding and/or willing to learn tribal health programs and alternate resources
• Knowledge and demonstrated use of customer service principles
• Knowledge of data entry, retrieval, and reporting
• Medical Terminology ICD-10CM, CPT & HCPCS codes
• Insurance authorization and benefits
• Anatomy and physiology
• General office functions, office equipment, and computer applications
• Detail oriented with above average organizational skills
• Skills in Effective oral and written communication skills
• Skills in using a database
• Skills in operating a computer utilizing a variety of software applications
• Working independently and as a team
• Good interpersonal, verbal, and written communication
• Strong attention to detail
• Ability to multi-task and work independently in a fast paced environment
• Ability to respond quickly in urgent situations with attention to detail
• Ability to problem solve and use conflict resolution skills
• 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
• Handle difficult customer situations in a positive manner
• Interact with external healthcare professionals in a variety of settings
• Effectively prioritize multiple ongoing tasks and responsibilities under pressure at a steady pace in an unpredictable environment
• Maintain a professional demeanor with physician and clinical team when addressing concerns regarding imaging orders/diagnoses

Benefits:

• $1,000 Sign On Bonus at start
• $1,000 Bonus after 12 months for qualified hire!
• Health insurance
• Retirement plans
• Paid time off
• Paid parental leave
• Dental and vision benefits
• Life insurance
• Long and short-term disability