Authorization Specialist II

Authorization Specialist

Pay Range: $25.00 - $33.71

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 obtain 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. Authorization Specialist expected to maintain strong working relationships with payers, SEARHC billing staff, and all other interdepartmental staff, and provide excellent customer service. This position is critical for reimbursement of costs relating to high dollar procedures and services provided to our patients.

SEARHC is a non-profit health consortium which serves the health interests of the residents of Southeast Alaska. We see our employees as our strongest assets. It is our priority to further their development and our organization by aiding in their professional advancement.

Working at SEARHC is more than a job, it's a fulfilling career. We offer generous benefits, including retirement, paid time off, paid parental leave, health insurance, dental, and vision benefits, life insurance and long and short-term disability, and more.

Key Essential Functions and Accountabilities of the Job

• 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 an 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 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.
• 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 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.

Other Functions:

• Other duties as assigned.

Additional Details:

Education, Certifications, and Licenses Required

• High School Diploma or equivalent – required.
• CHAA Certification within 6 months of hire

Experience Required

• Two years of experience as a Authorization Specialist - preferred.
• Or
• 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

• 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

Position Information:

Work Shift: OT 8/40

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!