Central Authorization Specialist

About the role

The Central Authorization Specialist centrally facilitates the successful procurement of insurance authorizations for ordered procedures and post-operative care. This role involves quality validation of obtained authorizations, continuous education, and feedback to a multi-disciplinary team to manage the cost of care and provide timely, accurate information to payors. The specialist drives change by identifying areas for performance improvement, such as workflow, education, process enhancements, and patient satisfaction.

The Central Authorization Specialist is accountable for a designated caseload, planning effectively to meet demands and support resources in procuring authorizations. Under general supervision and in accordance with established policies and procedures, this role includes:

• Serving as a subject matter expert in precertification and payor authorization processes.
• Ensuring successful authorizations are procured by ordering physician offices through validation of work effort and education of procuring staff.
• Obtaining and distributing feedback from coding, billing, and denial management resources to ordering physicians and authorization procurement staff to promote continuous improvement.
• Applying process improvement methodologies.
• Acting as a centralized resource for assigned specialty across all sites of practice to ensure standardized and consistent procurement of authorizations.

Requirements

• High School diploma or equivalent; 3–5 years of related experience and/or training, or an equivalent combination of education and experience.
• Minimum of 3–5 years of experience in a medical clinic setting or training in a hospital or corporate setting; must be highly computer literate.
• Two years of experience related to healthcare insurance verification and/or billing.
• Progressively responsible work experience (approximately 2–3 years) to gain an in-depth understanding of organizational policies, procedures, and operations.
• Coding knowledge and understanding of clinical terminology.
• Ability to interpret RN or physician notes to facilitate obtaining authorizations.
• Ability to evaluate and communicate additional requirements or roadblocks to RN/physician staff.
• Ability to interpret insurance records and related documentation.

Qualifications

• Understanding of patient treatment plans for purposes of obtaining authorizations.
• Organizational and time management skills, with the capacity to prioritize multiple tasks.
• Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients/families.
• Strong oral and written communication skills.
• Strong analytical and data management abilities.
• Ability to work with all levels of management.
• Strong interpersonal communication, negotiation skills, and experience interacting with clinicians and finance personnel.
• Additional coursework in business, computers, or healthcare administration (preferred).
• Experience in a medical or surgical specialty clinic (preferred).
• Current working knowledge of hospital operations, utilization management, case management, and managed care reimbursement (preferred).
• General understanding of the revenue cycle, with an emphasis on billing, coding, charge capture, and reimbursement (preferred).

Schedule

Day shift