Authorization Specialist

Job Title

Ensures timely verification and validation of authorizations for all Commercial and Managed care inpatients and other services as assigned.

Duties/Responsibilities

Ensure timely verification and validation of authorizations for all Commercial and Managed care inpatients and other services as assigned.

Contacts insurance companies via phone or website to secure authorization.

Reviews all discharged managed care patients for evidence of authorization entry in the Authorization module.

Obtains missing authorizations within 3 business days of patient's discharge or in some cases within 7 days of admission.

Checks bill hold weekly for pending authorizations.

Assists with sending delinquent reviews and resending reviews not received by the Payors.

Communicates effectively, builds and maintains professional, cooperative relationships with Case Management and all departments that have direct or indirect impact on obtaining authorizations.

Maintains analysis of authorization issues, by payer.

Reports monthly summary for authorization issues to senior leadership.

Clearly documents all contacts and authorization information for all types of authorizations in the hospital system, complete standardized documentation requirements in expected format.

Follows established hospital policies and procedures regarding authorization processes.

Other duties as assigned.

Education and Experience

High school diploma or combination of relevant experience and education.

Minimum of two (2) years of experience in a scheduling, authorization and referrals in a health care setting.

Required Skills/Abilities

Strong attention to detail.

Excellent communications skills both oral and written.

Excellent follow up and follow through skills.