Authorization Spec-Surg-Ancillary

Community Focused. Care Driven. Join Southcoast Health, where your future is as promising as the care we provide. Our commitment to each other, our patients, and our community is more than a mission – it’s our way of life, and you’ll be at the heart of it. Southcoast Health is a not‑for‑profit, charitable, health system with multiple hospitals, clinics, and facilities throughout southeastern Massachusetts and Rhode Island. It provides inclusive, ethical workplaces where highly skilled caregivers offer world‑class, comprehensive health care close to home. Position: Authorization Spec‑Surg‑Ancillary. Hours: 40 hrs. Shift: Day shift, 8:30am – 5:00pm, must work one minor holiday per year rotation. Location: Southcoast Business Center – Fairhaven, MA. A culture of well‑being that embraces, respects, and celebrates the rich diversity of one another and the communities we serve Competitive pay and comprehensive benefits package Generous Earned Time Off Package Employee Wellbeing Program 403B Retirement Plan with company match Tuition assistance / Federal Loan Forgiveness programs Professional growth opportunities and customized leadership training Available to regular status employees who are scheduled to work a minimum of 24 hours Southcoast Health is an Equal Opportunity Employer. Responsibilities Position reports to the Team Leader or designee. Perform a wide variety of duties to secure optimal revenue for all services performed at Southcoast facilities. Enter orders, schedule/cancel/reschedule appointments, determine patient liability prior to service by creating estimate based on individual payer, notify patients of their potential liability in accordance with Federal & State regulations and collect payment electronically. Initiate contact with patients, physicians, third party payers to obtain pre‑certification and authorization for all inpatient and outpatient services. Liaison between third party payers and providers, coordinate peer‑to‑peer discussions to authorize surgical and high‑dollar services. Use critical thinking skills to ensure CPT codes are documented and authorized for appropriate services. Partner with Care Coordination to determine and authorize appropriate level of care. Navigate multiple payer portals to determine requirements for authorization and submit electronic requests. Work with Pharmacy to determine appropriate infusion medication source and obtain authorization for medication/services. Follow‑up with payer denials by researching clinical data to support an appeal. Verify coverage and initiate authorization for new patients to be accepted to SE Rehab Department. Qualifications Associates Degree in a related field or equivalent combination of education and experience is required; Bachelors Degree preferred. Certificate in Medical Terminology is preferred. Coding experience is preferred. Strong keyboard skills with the ability to type 40 words per minute. Proven exceptional customer service skills. Ability to communicate with physicians, patients and third party payers. Proficient with navigating multiple payer portals and web based tools. Over three years of healthcare experience focusing on revenue cycle activities is preferred. Medical Terminology Certificate preferred. Must be fully vaccinated against seasonal Influenza and the COVID‑19 virus or to be exempt from the requirement for medical or personal reasons by signing a statement certifying you are choosing to be exempt from vaccination once hired. Compensation: Pay rate will be determined based on level of experience. Pay Range: USD $19.38 - $32.30 /hr. Rotation schedule: Must work one minor holiday per year. #J-18808-Ljbffr