Central Authorization Specialist /Full Time/ Remote-Michigan Residents

Central Authorization Specialist

The purpose of the Central Authorization Specialist position is to centrally facilitate the successful procuring of insurance authorizations for ordered procedures and post-operative care. This will be done through quality validations of obtained authorizations as well as continuous education and opportunity feedback to a multi-disciplinary team with the underlying objective of managing the cost of care and providing timely and accurate information to payors. The Central Authorization Specialist helps drive change by identifying areas where performance improvement is needed (e.g., day to day workflow, education, process improvements, patient satisfaction). The Central Authorization Specialist is accountable for a designated caseload and plans effectively in order to meet demands and support resources procuring authorizations. Under general supervision and in accordance with established policies and procedures the specific functions within this role include: Subject matter expertise of precertification and payor authorization processes. Ensure successful authorizations are procured by ordering physician offices through validation of work effort and education of procuring staff. Ensure feedback relevant to successful authorization procurement is obtained from back end coding, billing and denial management resources and distributed to ordering physicians and authorization procurement staff to promote continuous improvement. Application of process improvement methodologies. The responsibilities includes acting as a centralized resource for assigned specialty across all sites of practice to ensure standardized and consistent procurement of authorizations.

Education/Experience Required:

• High school diploma or 35 years of related experience/training (or equivalent combination), required
• Minimum 35 years of experience in a medical clinic setting or training in a hospital/corporate setting; must be highly computer literate, required
• Minimum 2 years of experience in healthcare insurance verification and/or billing, required
• 23 years of progressively responsible experience with organizational policies, procedures, and operations to handle high-level administrative responsibilities
• Knowledge of coding and clinical terminology
• Understanding of patient treatment plans for obtaining authorizations
• Ability to interpret RN/Physician notes to facilitate authorizations
• Ability to identify and communicate additional requirements or roadblocks to clinical staff
• Ability to interpret insurance records and related documentation
• Strong understanding of administrative workflows and healthcare processes

Preferred Qualifications:

• Additional coursework in business, computers, or healthcare administration
• Experience in a medical or surgical specialty clinic
• Working knowledge of hospital operations, utilization management, case management, and managed care reimbursement
• General understanding of the revenue cycle (billing, coding, charge capture, reimbursement)

Skills & Competencies:

• Strong organizational and time management skills; ability to prioritize multiple tasks
• Ability to work independently and exercise sound judgment
• Strong oral and written communication skills
• Strong analytical and data management skills
• Ability to work with all levels of management
• Strong interpersonal and negotiation skills, with experience interacting with clinicians and finance personnel