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Authorization Specialist
2 months ago
Job Title: Authorization Specialist
Job Summary:
The position of the Authorization Specialist coordinates the utilization review and appeals process as part of the denial management initiatives. This position is responsible for coordinating phone calls, data entry and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals. Document and track all communication attempts with insurance providers and health plans. This position will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office, and Case Managers. This position will also serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned. This position will further support the department needs for Release of Information, discharge coordination or other duties as assigned.
This position supports the Pipeline Health Culture Club Values through the provision of distinctive and compassionate care to our employees and patients. Actively and consistently contributes to department operations and communications, behaves in a manner consistent with the mission, vision, and values of Pipeline Health, upholding standards of AIDET (Acknowledge, Introduce, Duration, Explanation, Thank you) patient communication.
Qualifications/Experience:
- Minimum one (1) year of denials management experience in acute care setting highly preferred.
- Accurate alphabetic, numeric, and/or terminal-digit filing skills.
- Computer data entry with 10-key, with accurate typing speed of 35 wpm required. Excel skills highly preferred.
- Background in business and office training; preferred.
- Knowledge of terminal digit filing and medical terminology; preferred.
- Knowledge of State and Federal regulatory requirements for medical staff documentation; preferred.
Education:
Completion of a medical terminology course; preferred.
To learn more about Pipeline Health System, please follow the link below:
About Us- Pipeline Health
