Authorization Specialist II

About the role

The Authorization Specialist works with payers and SEARHC clinical staff to obtain initial and ongoing authorizations for patient services, verifies insurance benefits for each patient, and obtains authorizations for patients in accordance with the payer-provider contracts. They are responsible for tracking and correcting all pertinent insurance information in the electronic medical record. They are expected to maintain strong working relationships with payers, SEARHC billing staff, and all other interdepartmental staff, and provide excellent customer service.

Responsibilities

• Knows, understands, incorporates, and demonstrates the Mission, Core Values, and Vision in behaviors, practices, policies, and decisions.
• Maintains collaborative, team relationships with peers and colleagues to contribute to the working group's achievement of goals effectively, and to help foster a positive work environment.
• Protects confidentiality/privacy in verbal, written, and electronic forms of communication or information sharing.
• Raises concerns in an appropriate manner and according to policy.
• Consistently exhibits behavior and communication skills that demonstrate SEARHC’s commitment to superior customer service, including quality, care, and concern with each and every internal and external customer.
• Accurately captures and records inbound and outbound authorizations for patients and/or referring physician’s offices.
• Carries out due diligence to obtain authorizations from various insurance carriers via phone, in writing or email.
• Processes authorization-related denials and coordinates the appeal process with the appropriate Revenue Cycle staff members and clinical team.
• Work closely with the Financial Counselors and Patient Access team to ensure coverage is current and documented appropriately in the record.
• Ensures efficient documentation of information for insurance verification, registration and billing requirements and follows-up as needed.
• Responds to inquiries regarding status of authorization(s) by assessing the request and evaluating the circumstances to provide the needed information.
• Demonstrates superior customer service to all external and internal customers.
• Communicates effectively with patients, physicians, and/or other departments regarding delays or issues relating to authorizations and patient appointments.
• Maintains strict confidentiality at all times.
• Identifies compliance/ethics issues and brings forth recommendations for operational improvement.
• Ensures successful adherence to policies, procedures and changes to the organization.
• Complete and support additional patient access related activities as assigned.

Requirements

• High School Diploma or equivalent – required.
• CHAA Certification within 6 months of hire.
• Two years of experience as a Authorization Specialist - preferred.
• Or Two years of working in a healthcare, office, or customer service setting may be substituted.
• Knowledge of Understanding and/or willing to learn tribal health programs and alternate resources.
• Knowledge and demonstrated use of customer service principles.
• Knowledge of data entry, retrieval, and reporting.
• Anatomy and physiology.
• General office functions, office equipment, and computer applications.
• Detail oriented with above average organizational skills.

Qualifications

• Effective oral and written communication skills.
• Skills in using a database.
• Skills in operating a computer utilizing a variety of software applications.
• Working independently and as a team.
• Good interpersonal, verbal, and written communication.
• Strong attention to detail.
• Ability to multi-task and work independently in a fast paced environment.
• Ability to respond quickly in urgent situations with attention to detail.
• Ability to problem solve and use conflict resolution skills.
• Prioritize work in multi-task in a fast-paced office setting with many interruptions.
• Self-start and willingness to learn.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple instructions, short correspondence, and memos.
• Read and comprehend simple