Central Authorization Specialist /Full Time/ Remote-Michigan Residents

About the role

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.

Responsibilities

• 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.
• Apply process improvement methodologies.

Requirements

• High school diploma or 3–5 years of related experience and/or training, or an equivalent combination of education and experience (required)
• Minimum of 3–5 years of experience in a medical clinic, hospital, or corporate healthcare setting (required)
• Highly computer literate (required)
• Two years of experience in healthcare insurance verification and/or billing (required)
• Approximately 2–3 years of progressively responsible administrative experience with an in-depth understanding of organizational policies, procedures, and operations (required)
• Knowledge of medical coding (required)
• Knowledge of clinical terminology (required)
• Understanding of patient treatment plans for the purpose of obtaining insurance authorizations (required)
• Ability to interpret RN and physician documentation to facilitate authorizations (required)
• Ability to identify, evaluate, and communicate authorization requirements or barriers to RN and physician staff (required)
• Additional coursework in business, computer science, or healthcare administration (preferred)
• Experience in a medical or surgical specialty clinic (preferred)
• Ability to interpret insurance records and related documentation (required)
• Working knowledge of hospital operations, utilization management, case management, and managed care reimbursement (preferred)
• General understanding of the revenue cycle, including billing, coding, charge capture, and reimbursement (preferred)
• Strong organizational and time management skills with the ability to prioritize multiple responsibilities (required)
• Ability to work independently and exercise sound judgment when interacting with physicians, payers, patients, and families (required)
• Strong verbal and written communication skills (required)
• Strong analytical and data management skills (required)
• Ability to collaborate effectively with all levels of management (required)
• Excellent interpersonal communication and negotiation skills, with experience working alongside clinicians and finance personnel (required)

Qualifications

• High school diploma or equivalent (required)
• 3–5 years of related experience or training (required)
• Minimum of 3–5 years of experience in a medical clinic, hospital, or corporate healthcare setting (required)
• Highly computer literate (required)
• Two years of experience in healthcare insurance verification and/or billing (required)
• Approximately 2–3 years of progressively responsible administrative experience with an in-depth understanding of organizational policies, procedures, and operations (required)
• Knowledge of medical coding (required)
• Knowledge of clinical terminology (required)
• Understanding of patient treatment plans for the purpose of obtaining insurance authorizations (required)
• Ability to interpret RN and physician documentation to facilitate authorizations (required)
• Ability to identify, evaluate, and communicate authorization requirements or barriers to RN and physician staff (required)
• Additional coursework in business, computer science, or healthcare administration (preferred)
• Experience in a medical or surgical specialty clinic (preferred)
• Ability to interpret insurance records and related documentation (required)
• Working knowledge of hospital operations, utilization management, case management, and managed care reimbursement (preferred)
• General understanding of the revenue cycle, including billing, coding, charge capture, and reimbursement (preferred)
• Strong organizational and time management skills with the ability to prioritize multiple responsibilities (required)
• Ability to work independently and exercise sound judgment when interacting with physicians, payers, patients, and families (required)
• Strong verbal and written communication skills (required)
• Strong analytical and data management skills (required)
• Ability to collaborate effectively with all levels of management (required)
• Excellent interpersonal communication and negotiation skills, with experience working alongside clinicians and finance personnel (required)

Skills

• Subject matter expertise of precertification and payor authorization processes
• Validation of work effort and education of procuring staff
• Obtaining feedback from back end coding, billing and denial management resources
• Distribution of feedback to ordering physicians and authorization procurement staff
• Application of process improvement methodologies

Benefits

The health and overall well-being of our team members is our priority. That's why we offer support in the various components of our team's well-being: physical, emotional, social, financial, and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan, and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses, and more. Employees classified as contingent status are not eligible for benefits.

Pay

Details about pay are not specified in the job posting.

Schedule

Details about schedule are not specified in the job posting.