Pre-Authorization SME
2 weeks ago
Position Overview
The Authorization SME will be responsible for obtaining authorization on critical cases from the Payers for procedures. They will work closely with the offshore team. and will be responsible to coach and provide guidance to them on best practices and issue resolution.
The SME’s will also play integral roles in engaging with new clients, understanding their current state and setting up delivery.
This is a critical function, since patient care depends on the approval of the authorization obtained for the services required.
Job Description
Understanding of the Specialty
Thorough understanding of the procedures and diagnosis which requires authorization
Interpretation of the medical records
Thorough understanding of the treatment protocols of the speciality
Understanding of the diagnosis which will be paid as per the speciality nuances
Understanding of CPT diagnosis combination
Ability to work on more than one client (more EHR)
Understanding of Payer Nuances
Detailed authorization submission protocols
Skill to get the authorization approved with providing the required information as needed by the Payor
Ability to talk with the NP’s if the authorization goes in pending status
Understanding of documentation required for obtaining authorization
Good understanding of the payor policies
Ability to do Peer to Peer with the Payer
Additional Responsibilities
Ability to coach new clinical authorization specialists on prior authorization, medical policy reviews and standard workflows
Provide ongoing support for existing clinical authorization specialists on new workflows, changes in workflow and general updates or reminders
Complete quality improvement and productivity activities
Candidate Profile
Essential:
Ability to pass background check and drug test
High School Diploma or equivalent or NP
Experience in obtaining authorization (including surgeries and procedures)
Understanding of EHR systems
Hands on experience of handling authorization denials and appeals
Strong attention to detail
Good verbal and written communication skills
Ability to work with Global teams
Desirable:
Prior work experience of US healthcare in other functions.
IKS Health is a leading global healthcare company that provides a suite of products and services that help US-based healthcare providers operate more effectively and efficiently. Founded in 2007, IKS has over 5,500 employees, including about 1,000 clinicians, based at our offices in Dallas, Los Angeles, Hyderabad, and Mumbai. We work for 35 large US-based healthcare organizations, including the Massachusetts General Brigham; Mayo Clinic; Beth Israel Lahey; and several of the top-20 health systems in the US. IKS has a collaboration agreement with the prestigious Massachusetts General Hospital’s medical group to develop innovative clinical services that address the needs of US healthcare organizations..
IKS Health offers a Provider Enablement Solution that helps medical groups, health systems, and other ambulatory (i.e. outpatient) healthcare organizations to deliver superior patient care, while ensuring provider delight and financial upsides. Our solutions help healthcare organizations focus on their “core” functions of patient care and provider enablement (i.e. enabling physicians and other providers to take better care of patients), while IKS takes over the “chores” (such as financial, clinical support, and technology processes). We believe IKS is a pioneer in the use of clinical support services using a global delivery model.Company DescriptionAbout IKS Health\r
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IKS Health is a leading global healthcare company that provides a suite of products and services that help US-based healthcare providers operate more effectively and efficiently. Founded in 2007, IKS has over 5,500 employees, including about 1,000 clinicians, based at our offices in Dallas, Los Angeles, Hyderabad, and Mumbai. We work for 35 large US-based healthcare organizations, including the Massachusetts General Brigham; Mayo Clinic; Beth Israel Lahey; and several of the top-20 health systems in the US. IKS has a collaboration agreement with the prestigious Massachusetts General Hospital’s medical group to develop innovative clinical services that address the needs of US healthcare organizations..\r
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IKS Health offers a Provider Enablement Solution that helps medical groups, health systems, and other ambulatory (i.e. outpatient) healthcare organizations to deliver superior patient care, while ensuring provider delight and financial upsides. Our solutions help healthcare organizations focus on their “core” functions of patient care and provider enablement (i.e. enabling physicians and other providers to take better care of patients), while IKS takes over the “chores” (such as financial, clinical support, and technology processes). We believe IKS is a pioneer in the use of clinical support services using a global delivery model.
