Specialist-Authorization Denial

Responsibilities

• Obtain and review treatment/therapy plan orders for medical necessity and appropriateness according to insurance medical policy/FDA/NCCN guidelines and requirements.
• Research insurance company medical policies, medical literature, and compendiums to determine eligibility for services.
• Utilize multiple healthcare websites.
• Works closely with physicians and clinic staff to obtain authorizations to promote positive patient outcomes, timely treatment, and positive reimbursement.
• Reviews, assesses, and evaluates all authorization denial communications received in order to optimize reimbursement.

Requirements

• 3 – 5 years of business experience in a healthcare environment with 2 of those years being in a clinical setting.
• Preferred/Desired: 5 years of business experience in a healthcare environment with at least 3 years payer specific experience.
• 3 years clinical experience in a clinical care setting.
• Pre-certification experience desired.

Qualifications

• Minimum Required: Requires critical thinking and judgement.
• Preferred/Desired: Must demonstrate the ability to appropriately use standard criteria established by payers.
• Requires excellent customer service and communication skills, including the ability to speak, articulate, and be understood clearly.
• Must have advanced computer literacy skills and problem-solving skills.
• Must be able to multi-task and be flexible.
• Must be able to deal with confrontational issues and high stress situations with patients, family, and physicians.

Skills

• Strong organizational skills.
• Ability to type and/or key correctly.

Benefits

Not specified.

Pay

Not specified.

Schedule

Not specified.