Authorization Specialist

About the role

The Authorization Specialist is responsible for creating hospital encounters for surgical services throughout Park Nicollet Ambulatory Surgery Centers and Methodist Hospital. This position completes insurance verification, obtains and documents prior authorization approvals from insurance companies for procedures and hospital stays. In collaboration with the Care Team, the Authorization Specialist obtains and submits clinical documentation pertinent to the specific services requiring authorization for payer review. The role maintains and updates documentation related to changes in payer prior-authorization, pre-certification, and notification requirements by reviewing insurance payer bulletins and publications. This position must attend continuing education classes and complete mandatory training to maintain department-specific requirements and professional growth. Effective performance of these functions helps the organization achieve strong cash flow and maximize patient satisfaction.

Responsibilities

• Create hospital encounters for surgical services.
• Complete insurance verification for procedures and hospital stays.
• Obtain and document prior authorization approvals from insurance companies.
• Collaborate with the Care Team to submit clinical documentation for payer review.
• Maintain and update documentation regarding payer prior-authorization, pre-certification, and notification requirements.
• Review insurance payer bulletins and publications for updates.
• Attend continuing education classes and complete mandatory training.

Requirements

Education, Experience, or Equivalent Combination:

• High school diploma or equivalent.

Skills

• Demonstrated PC and keyboard experience.
• Strong customer service skills.
• Effective written and verbal communication skills.
• Knowledge of EPIC registration and/or any electronic health record.
• Ability to work cohesively and respectfully with a diverse workforce and patient population.
• Critical thinking skills for complex situations.
• Knowledge of patient eligibility and related systems.
• General knowledge of the hospital billing cycle.
• Effective time management and problem-solving skills.
• Ability to maintain composure under stressful situations.
• Proficiency with Epic, personal computers, word processing, spreadsheets, and email.
• Working knowledge of Microsoft Suite (e.g., Word, Excel, Outlook).
• Familiarity with typical office equipment.
• Ability and expectation to successfully complete a competency examination on insurance selection/process upon completion of training and annually thereafter.
• Ability and expectation to demonstrate competency on insurance selection/process on a monthly basis.

Preferred Qualifications

Education, Experience, or Equivalent Combination:

• Post high school degree or certification.
• Healthcare registration experience.
• Healthcare revenue cycle experience.

Knowledge, Skills, And Abilities:

• 2 years of previous healthcare experience, which may include medical terminology, insurance eligibility, prior authorizations, and ICD/CPT coding experience.

Benefits

• Medical insurance.
• Dental insurance.
• Retirement program.
• Paid time off.
• Insurance options.
• Tuition reimbursement.
• Employee assistance program.
• Onsite clinic.

About Us

At HealthPartners, we believe in the power of good—good deeds and good people working together. As part of our team, you’ll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work. We’re a nonprofit, integrated health care organization providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improves lives around the world. We are committed to increasing diversity and inclusion in our workplace, advancing health equity in care and coverage, and partnering with the community as advocates for change.