CentralAuthorizationSpecialist

The 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 include acting as a centralized resource for assigned specialty across all sites of practice to ensure standardized and consistent procurement of authorizations.

• Education: High school diploma or equivalent combination of education/experience
• Experience: 3-5 years in a medical clinic, hospital, or corporate setting
• Healthcare: 2+ years of insurance verification and/or billing experience
• Authorization: Experience obtaining insurance authorizations and interpreting treatment plans/RN or physician notes
• Knowledge: Medical coding, clinical terminology, insurance records, and revenue cycle
• Preferred: Medical/surgical specialty clinic experience; knowledge of hospital operations, utilization/case management, and managed care reimbursement
• Technical: Highly computer literate; strong data management skills
• Communication: Strong written/verbal, interpersonal, and negotiation skills
• Collaboration: Comfortable working with physicians, nurses, payors, patients, finance teams, and leadership
• Organization: Strong time management and ability to prioritize multiple tasks
• Judgment: Able to work independently and resolve issues/authorization roadblocks effectively

Additional Information

• Organization: Corporate Services
• Department: CBO Central Authorization Unit
• Shift: Day Job
• Union Code: Not Applicable