Authorization Specialist

Summary Obtains benefits and authorizations for surgical procedures, diagnostic testing, medications, outgoing referrals, and other services as part of daily operations. Determines the authorization protocols for each health plan and performs billing duties to ensure proper and timely payment is received from insurance carriers and patients. Job Duties Collaborates with physicians and provider office staff in ascertaining the appropriate authorization based on medical necessity and the treatment plan provided. Performs a medical necessity check to determine if procedure and diagnosis support medical necessity. Ensures authorizations are obtained in accordance to network policy (any authorization not falling into policy guidelines is communicated to ordering office, patient, and manager). Communicates direct/indirect with insurance companies to obtain insurance verification, benefits and precertification for approval. Verifies additional clinical information and insurance authorizations/referrals. Reviews and monitors WQs/schedules to ensure that proper and accurate authorization has been received prior to patient’s visit. Maintains compliance with benchmark data regarding accounts registered versus scheduled procedures. Determines estimated patient financial responsibility using insurance verification information and payer contracts and/or self-pay guidelines. Minimum Qualifications High School Diploma/GED with specialized training in insurance, coding, billing, or similar healthcare certificate programs. 1 year in a healthcare setting with insurance verification/authorizations. Familiarity with billing procedures and payer reimbursement. Knowledge of patient rights and laws relative to those rights, such as HIPAA. Proficient in utilization management processes, standards, and managed care. Proficient in standard medical practices and insurance benefit structures. Preferred Qualifications Associate’s Degree. Physical Demands Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use. Patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR. Job Description Disclaimer This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require. Employment Details Work Shift: Day Shift Work Schedule: Monday-Friday; 8:00a-4:30p Primary Location: REMOTE IN PENNSYLVANIA Address: 1200 S Cedar Crest Blvd Department: COH-Precertification Dept Position Type: Remote Equal Opportunity Statement Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities. #J-18808-Ljbffr