AddressThe 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 includes acting as a centralized resource for assigned specialty across all sites of practice to ensure standardized and consistent procurement of authorizations.
- High School or 3 - 5 years related experience and/or training; or equivalent combination of education and experience, required.
- Minimum of 3-5 years of experience in a medical clinic setting or training in a hospital or corporate setting; must be highly computer literate, required.
- Two years of experience related to healthcare insurance verification and/or billing required.
- Approximately two to three years progressively more responsible related work experience necessary in order to gain in-depth understanding or organizational policies, procedures and operations, in order to assume a variety of high-level administrative details.
- Coding knowledge. Knowledge of clinical terminology.
- Understanding of patient treatment plans for purposes of obtaining authorizations.
- Ability to interpret RN or Physician notes in order to facilitate obtaining authorizations.
- Ability to evaluate & communicate to RN/Physician staff additional requirements or roadblocks.
- Additional coursework in business, computers or health care administration, preferred.
- Experience in a medical or surgical specialty clinic, preferred.
- Ability to interpret insurance records and related documentation.
- Current working knowledge of hospital operations, utilization management, case management, and managed care reimbursement, preferred.
- General understanding of revenue cycle with an emphasis on billing, coding, charge capture and reimbursement, preferred.
- Organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
- Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families if required.
- Strong oral and written communication skills required.
- Strong analytical and data management.
- Ability to work with all levels of management.
- Strong interpersonal communication and negotiation skills and experience interacting with clinicians and finance personnel.
