Central Authorization Specialist

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 of education and experience) required
• 35 years of experience in a medical clinic, hospital, or corporate training setting required
• Highly computer literate required
• 2 years of healthcare insurance verification and/or billing experience required
• 23 years of progressively responsible experience with organizational policies, procedures, operations, and high-level administrative responsibilities
• Knowledge of:
  • Medical coding
  • Clinical terminology
  • Patient treatment plans for authorization purposes
  • Revenue cycle processes including billing, coding, charge capture, and reimbursement preferred
  • Hospital operations, utilization management, case management, and managed care reimbursement preferred
• Ability to:
  • Interpret RN/physician notes to obtain authorizations
  • Identify and communicate authorization requirements or roadblocks to clinical staff
  • Interpret insurance records and related documentation
  • Work independently and exercise sound judgment with physicians, payors, patients, and families
  • Prioritize multiple tasks and responsibilities
  • Work effectively with all levels of management
• Additional coursework in business, computers, or healthcare administration preferred
• Experience in a medical or surgical specialty clinic preferred
• Strong:
  • Organizational and time management skills
  • Oral and written communication skills
  • Analytical and data management skills
  • Interpersonal communication and negotiation skills
• Experience interacting with clinicians and finance personnel