Authorization Specialist

Job Summary

Coordinates precertification/authorization services for patients across the continuum of care promoting quality care and effective utilization of resources. Provides leadership when dealing with patient preauthorization functions including inpatient and outpatient services. Coordinates efforts between departments to ensure accurate precertification resulting in timely billing of claims. Some overtime and call back may be required. Performs other duties as assigned.

Responsibilities

• Precertifies patient care services that require precertification in a timely efficient manner in order to optimize reimbursement for the patient as well as health care providers.
• Communicates recommendations clinical information and fiscal information to appropriate internal and external customers in order to facilitate optimal delivery of services and customer satisfaction.
• Reviews orders for accuracy and medical necessity to facilitate delivery of services and appropriate reimbursement.
• Addresses issues identified with retrospective reviews for all payers.
• All outpatient procedures will be timely precerted when applicable.
• Works to improve the QI/PI process.
• Assumes responsibility for personal growth and development by attendance and / or participation in inservices and continuing education programs.
• Completes assigned goals.

Specifications

Experience

Minimum Required

• 2 years of office and/or clinical experience.

Preferred/Desired

• Prefer experience in a clinic setting as well as dealing with prior authorizations.

Education

Minimum Required

• Knowledge of medical terminology

Preferred/Desired

• Associates degree in related field

Training

Minimum Required

Preferred/Desired

Special Skills

Minimum Required

• Advanced communication conflict management organizational and planning skills; advanced computer literacy skills.

Preferred/Desired

Licensure

• LPN license

Minimum Required

Preferred/Desired

• LPN