Authorization Specialist II

Department/Unit:

Patient Engagement Center

Work Shift:

Day (United States of America)

Salary Range:

$50,639.00 - $75,959.00

The Authorization Specialist II (AS II) is responsible for financially securing Ambulatory, Ancillary, Surgical and Procedural services. This includes securing Referral and Authorization. Insurance Verification and Benefit interpretation to discern insurance guidelines are being adhered to. Ability to interact with patients and stakeholders for the successful financial clearance will be critical to be successful in the compliance of authorization and referral guidelines. Position requires ability to work in a high-volume, fast-paced environment. Understanding complex scheduling needs of our patients in an empathetic, compassionate manner is critical. Position is required to use eligibility application and authorization portals to invoke request to verify insurance eligibility, interpret response and capture appropriate health insurance information as it pertains to the service being rendered. The position requires ability to understand and apply contractual benefits to the service being rendered, with ability to collect patient financial obligation pre-services. Additionally, the AS II has responsibility to onboard new team members, post their successful completion of The Academy.

Essential Duties and Responsibilities

• Responsible for financial clearance of scheduled services for Hospital Surgical (Inpatient and Outpatient) and Clinic appointments, assuring no delay in payment of claim.
• Precept new team members for successful onboarding to the Authorization Specialist I position.
• Ability to identify authorization needs including but not limited to Out of Network management of appointments and encounters.
• Responsible to interpret information received from Insurance Payer regarding patient’s eligibility and financial responsibility
• Responsible to discuss financial obligation to patient, if required.
• Ability to accurately interpret referral/physician order to meet the patient and/or provider need for scheduling of services correctly including multi-scheduling needs for related services
• Responsible for scanning or managing online form template to maintain the Electronic Health Record
• Comprehend Federal, State, Third Party Payer regulations as it pertains to a hospital and practice pre-registration.
• Excellent knowledge of third- party payer authorization portals; authorization guidelines by payer and critical detail to follow up.
• Responsible for review of services being rendered to ensure the appropriate setting of care has been assigned by the physician’s office
• Obtains all insurance information from patient and verifies insurance to ensure active coverage for services being scheduling and obtains authorization via portal, fax and telephone.
• Provides thorough comments, where applicable for all conversations with patients or providers.
• Ability to organize work with multiple steps to ensure no scheduling or authorization needs are missed.

Qualifications

• Associate's Degree - required
• Bachelor's Degree - preferred
• 3 – 5 years’ experience in Hospital or Physician office experience or call center environment, - preferred
• Strong insurance knowledge specific to complex scheduling needs and authorization management
• Ability to precept new team members
• Proven customer service skill with ability to exceed expectations
• Demonstrated knowledge payer authorization requirements
• Strong attention to detail
• Ability to multi-task in stressful and high patient volume unit
• Must be able to manage pressure of very tight timeframes to execute task
• Ability to learn in classroom, utilizing resources
• Ability to remain composure under pressure
• Ability to train and onboard colleague
• Ability to review information and draw appropriate conclusion
• Good judgement and ability to be resourceful to problem solve; escalate issues as needed
• Team minded worth ethic
• Demonstrated ability interpret patient’s insurance benefits and apply the applicable contractual obligations
• Critical thinking ability regarding issues with financially securing payment
• CHAA (or acquired within 2 years of hire) - required
• Learning Partner Module

Equivalent combination of relevant education and experience may be substituted as appropriate.

Physical Demands

• Standing - Occasionally
• Walking - Occasionally
• Sitting - Constantly
• Talking - Frequently
• Hearing - Frequently
• Repetitive Motions - Frequently

Thank you for your interest in Albany Medical Center!

Albany Medical Center is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Medical Center, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:

Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Medical Center policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.

Thank you for your interest in Albany Med Health System!

Albany Med Health System is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Med Health System, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:

Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Health System policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.