Authorization Specialist I

Department/Unit: Patient Access • Work Shift: Day

About the role

The Authorization Specialist I (AS I) is responsible for financially securing Ambulatory, Ancillary, Surgical, and Procedural services. This includes securing Referral and Authorization, Insurance Verification, and Benefit interpretation to ensure insurance guidelines are adhered to. The role requires interacting with patients and stakeholders to achieve successful financial clearance while complying with authorization and referral guidelines. The position operates in a high-volume, fast-paced environment and demands an understanding of complex scheduling needs with empathy and compassion.

Responsibilities

• Financially clear scheduled services for Hospital Surgical (Inpatient and Outpatient) and Clinic appointments to prevent delays in claim payment.
• Identify authorization needs, including Out of Network management of appointments and encounters.
• Interpret information from Insurance Payers regarding patient eligibility and financial responsibility.
• Discuss financial obligations with patients when required.
• Accurately interpret referral/physician orders to meet patient and/or provider needs for correct scheduling, including multi-scheduling for related services.
• Scan or manage online form templates to maintain the Electronic Health Record.
• Comprehend Federal, State, and Third Party Payer regulations related to hospital and practice pre-registration.
• Utilize third-party payer authorization portals and follow authorization guidelines by payer, including critical follow-up details.
• Review services to ensure the appropriate setting of care has been assigned by the physician’s office.
• Obtain all insurance information from patients, verify active coverage for scheduled services, and secure authorization via portal, fax, or telephone.
• Provide thorough comments for all conversations with patients or providers.
• Organize work with multiple steps to ensure no scheduling or authorization needs are missed.

Requirements

• Ability to use eligibility applications and authorization portals to verify insurance eligibility, interpret responses, and capture appropriate health insurance information.
• Understand and apply contractual benefits to services rendered, including collecting patient financial obligations pre-service.
• Ability to elevate to AS II per Career Ladder Guidelines.

Pay

$49,763.00 - $69,668.00