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 include 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 required OR 35 years of related experience/training OR equivalent combination of education and experience (required)

• (Required) Minimum 35 years of experience in:
  • Medical clinic setting OR
  • Hospital/corporate training environment
• Highly computer literate required
• Minimum 2 years of experience in:
  • Healthcare insurance verification and/or
  • Medical billing
• 23 years of progressively responsible experience handling:
  • Administrative operations
  • Organizational policies and procedures
  • High-level administrative responsibilities
• Coding knowledge required
• Knowledge of clinical terminology required
• Understanding of patient treatment plans for authorization purposes
• Ability to:
  • Interpret RN and physician notes
  • Obtain insurance authorizations
  • Identify and communicate authorization barriers or additional requirements to clinical staff
• Additional coursework in:
  • Business
  • Computer systems
  • Healthcare administration preferred
• Experience in a medical or surgical specialty clinic preferred
• Ability to interpret:
  • Insurance records
  • Related healthcare documentation
• Working knowledge of:
  • Hospital operations
  • Utilization management
  • Case management
  • Managed care reimbursement preferred
• General understanding of healthcare revenue cycle preferred, including:
  • Billing
  • Coding
  • Charge capture
  • Reimbursement
• Strong organizational and time management skills
• Ability to prioritize multiple tasks and responsibilities effectively
• Ability to work independently and exercise sound judgment with:
  • Physicians
  • Payors
  • Patients and families
• Strong oral and written communication skills required
• Strong analytical and data management skills required
• Ability to work effectively with all levels of management
• Strong interpersonal communication and negotiation skills
• Experience collaborating with:
  • Clinicians