Authorization Specialist

SUMMARY

Ensures timely verification and validation of authorizations for all Commercial and Managed care inpatients and other services as assigned.

Duties/Responsibilities:

• Ensure timely verification and validation of authorizations for all Commercial and Managed care inpatients and other services as assigned.
• Contacts insurance companies via phone or website to secure authorization.
• Responsible to review all discharged managed care patients for evidence of authorization entry in the Authorization module.
• Obtains missing authorizations within 3 business days of patient’s discharge or in some cases within 7 days of admission.
• Responsible for checking bill hold weekly for pending authorizations.
• Assists with sending delinquent reviews and resending reviews not received by the Payors.
• Communicate effectively, build and maintain professional, cooperative relationships with Case Management and all departments that have direct or indirect impact on obtaining authorizations.
• Maintains analysis of authorization issues, by payer.
• Reports monthly summary for authorization issues to senior leadership.
• Clearly documents all contacts and authorization information for all types of authorizations in the hospital system, complete standardized documentation requirements in expected format.
• Follows established hospital policies and procedures regarding authorization processes.
• Other duties as assigned.

Education and Experience:

• High school diploma or combination or relevant experience and education
• Minimum of two (2) years of experience in a scheduling, authorization and referrals in a health care setting

Required Skills/Abilities:

• Strong attention to detail
• Excellent communications skills both oral and written
• Excellent follow up and follow through skills