Authorization Specialist

Imagine a career at one of the nations most advanced health networks.

Be part of an exceptional health care experience. Join the inspired passionate team at Lehigh Valley Health Network a nationally recognized forward-thinking organization offering plenty of opportunity to do great work.

LVHN has been ranked among the Best Hospitals by U.S. News & World Report for 23 consecutive years. Were a Magnet(tm) Hospital having been honored five times with the American Nurses Credentialing Centers prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally Lehigh Valley Hospital - Cedar Crest Lehigh Valley Hospital - Muhlenberg Lehigh Valley Hospital- Hazleton and Lehigh Valley Hospital - Pocono each received an A grade on the Hospital Safety Grade from The Leapfrog Group in 2020 the highest grade in patient safety. These recognitions highlight LVHNs commitment to teamwork compassion and technology with an unrelenting focus on delivering the best health care possible every day.

Whether youre considering your next career move or your first you should consider Lehigh Valley Health Network.

• Collaborates with physicians and provider office staff in ascertaining the appropriate authorization based on medical necessity and the treatment plan provided.
• Performs a medical necessity check to determine if procedure and diagnosis support medical necessity.
• Ensures authorizations are obtained in accordance to network policy (any authorization not falling into policy guidelines is communicated to ordering office patient and manager).
• Communicates direct/indirect with insurance companies to obtain insurance verification benefits and precertification for approval.
• Verifies additional clinical information and insurance authorizations/referrals.
• Reviews and monitors WQs/schedules to ensure that proper and accurate authorization has been received prior to patients visit.
• Maintains compliance with benchmark data regarding accounts registered versus scheduled procedures.
• Determines estimated patient financial responsibility using insurance verification information and payer contracts and/or self-pay guidelines.

• High School Diploma/GED with specialized training in insurance coding billing or similar healthcare certificate programs.
• 1 year in a healthcare setting with insurance verification/authorizations.
• Familiarity with billing procedures and payer reimbursement.
• Knowledge of patient rights and laws relative to those rights such as HIPAA.
• Proficient in utilization management processes standards and managed care.
• Proficient in standard medical practices and insurance benefit structures.

• Associates Degree

Lehigh Valley Health Network is an equal opportunity accordance with and where applicable in addition to federal state and local employment regulations Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race color religion sex age national origin sexual orientation gender identity disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include but are not limited to recruitment selection hiring transfers promotions terminations compensation benefits educational programs and/or social activities.

Valley Health Network does not accept unsolicited agency resumes. Agencies should not forward resumes to our job aliases our employees or any other organization location. Lehigh Valley Health Network is not responsible for any agency fees related to unsolicited resumes.

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