AUTHORIZATION SPEC I
US-WA-Wenatchee
External
Req #: 14896
Type: Full-Time
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Overview: The Authorizations Specialist is responsible for determining when an authorization is required for healthcare services and for submitting prior authorization requests in accordance with health plan requirements. Documents all authorization information and determinations in the patient's electronic medical record. Proper execution of this work directly impacts revenue for the organization and supports its denial management and prevention strategies. Position Reports To: Authorization Manager Responsibilities: * Researches prior authorization requirements and submits prior authorization requests in a timely manner. * Researches, recognizes, requests, and submits the clinical documentation required to support the medical necessity of the service being authorized. * Properly documents all authorization requests and decisions in the patient's auth/cert or referral record utilizing standard EPIC workflows and work queues. * Accurately interprets medical policies and how they pertain to services being authorized. * Utilizes payor tools and websites as needed to facilitate prior authorization requests. * Verifies insurance eligibility and benefits and updates patient insurance information as needed. * Reviews and resolves all reported authorization issues. * Proactively researches and stays informed of changing insurance pre-authorization requirements and health plan updates. * Communicates with providers, Staff, and Patients to keep them apprised of the status of the authorization requests and processes denied authorizations in a timely manner. * Keeps pace with workflow by remaining up to date on work and preventing backlog in workflows. * Collaborates with teammates and leadership to identify process improvements and optimizations. * Advises leadership of payor trends and issues. * Develops and maintains positive rapport with both internal and external customers. * Participates in team huddles, meetings, and trainings as required by leadership to maintain collaboration, continuing education, and team synergy. * Performs other duties as assigned. Demonstrate standards of behavior and adhere to the Code of Conduct in all aspects of job performance at all times. Qualifications: Required: * High School Graduate or equivalent with 1 year of experience in a hospital or physician office. * Understanding of health insurance and the concept of referrals/pre-authorizations and their intended impact on health care delivery and reimbursement. * Ability to prioritize workload and meet deadlines while being flexible to the changing demands of coverage. * Possesses intermediate computer skills (e.g., spreadsheets, word processing); knowledge of MS Office. * Effective written and verbal communication and reading comprehension skills. * Ability to multi-task and thrive in a dynamic and fast-paced environment. Desired: * Experience in CPT/ICD-10 coding. * Experience investigating claim denials. * EPIC experience in Prelude, Cadence, Grand Central, and/or Resolute applications. * Knowledge and interpretation of medical terminology. * Demonstrated experience with insurance requirements surrounding referrals and/or prior authorizations for therapies, surgeries, procedures, diagnostic testing, etc. * MA-R Certification.
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