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RN Authorization Specialist

4 months ago

Greenfield, United States Hancock Regional Hospital Full time
Category
Network Navigation - 8212

Description

JOB SUMMARY: The Authorization Specialist are a critical part of the Network Navigation department and serve as a resource for both the Authorization Advocate and the patient. This role is responsible for resolving more complex pre-certification, authorization and referral needs. Responsible for working with physicians, physician offices, insurance companies and the Authorization Advocates to answer patient questions and resolve patient issues. Additionally, this role will serve as back-up when the Authorization Advocates have scheduling issues or an influx of patients that need their referrals processed, or pre-certifications checked before scheduling.

The Authorization Specialist must be self-driven and able to multitask and prioritize their work. They must have strong communication skills with an understanding of medical terminology and be able to deal effectively with others. This position is team-oriented and contributes to achieving department goals.

QUALIFICATIONS:

JOB SPECIFIC CORE COMPETENCIES:
  • Customer Service-oriented: The Authorization Specialist should be extremely customer service-oriented, with a patient first attitude.
  • Communication skills: The Authorization specialist will have strong written and verbal communication skills, and excellent spelling. Demonstrated knowledge of medical terminology. They will have excellent communication and interpersonal skills, especially when it comes to interacting with patients and other hospital associates over the phone or in person if required.
  • Organizational skills: This role requires strong administrative and organizational skills to help manage responsibilities effectively.
  • Attention to detail: The Authorization specialist should have the ability to multitask and maintain a strong attention to detail, with good analytical and problem solving skills
  • Technical skills: Proficiency in Microsoft Office suite (Outlook, Excel, Word); experience with Meditech preferred but not required.
  • Ability to function independently and as a team player in a fast-paced environment
  • Strong written and verbal communication skills and excellent spelling
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
  • Independently able to retrieve orders from worklists.
  • Able to verify provider orders, authorizations, and locations - ensuring that all information match perfectly.
  • Access insurance company databases to gain prior authorizations and pre-certifications.
  • Detailed and accurate chart documentation outlining details set forth by department protocol and insurance regulations outlining precertification information for the patient.
  • Process referrals and pre-certifications efficiently including gathering detailed medical records, contacting the patient to provide updates on their referral status and faxing the referral to the appropriate specialty office.
  • Process pre-certifications efficiently including gathering detailed medical records and contacting the patient to provide updates on their order status
  • Ongoing communication with specialty offices to ensure that patients have been scheduled.
  • Work collaboratively with other Specialists, Leads and Advocates on process improvement projects.
  • Accurately enter required information (clinical and non-clinical) into patients' chart
  • Act as a clinical resource for the Authorization Advocates as well as the entire Network Navigation team and peers within Hancock Health.
  • Excellent and continuous communication between the patient, provider offices, insurance companies and peers
  • Maintain patient confidentiality as defined by state, federal and company regulations.
  • Validate benefit coverage per established procedures.
  • Performs any other task related duties as assigned by the Director.
  • All obligations pertaining to the position's description is subject to change at any time.
  • Demonstrate ability to schedule, re-schedule and cancel patients' appointments throughout Hancock Health
COMPETENCIES

Demonstrates the following competencies:
  • Communication and Interpersonal
    • Focus on the needs of the patient with each interaction.
    • Answers phone calls promptly and courteously with a smile to provide a positive impression of Hancock Health.
    • Directs calls appropriately for patient assistance.
    • Effectively communicates in a timely and professional manner
    • Answer high-volume inbound customer calls via an automated phone system
    • Make outbound calls to patients, referrals, and sales as needed
    • Utilize resources to troubleshoot and resolve patient issues
    • Dedicated to providing best first impressions for our patients, visitors, physicians, and associates.
    • Demonstrated oral communication skills needed to develop patient rapport and ability to independently address patient needs as appropriate.
    • Resolves all clinical questions within scope of knowledge while providing excellent customer service on the phone and/or in person
    • Schedules any necessary follow up appointments for patients, including any specialty or ancillary services as possible
    • Assists with referrals and pre-certifications, at the time of encounter
    • Properly utilizes and maintains patient recall and reschedule lists
    • Maintains a high regard for confidentiality and abides by organizational and HIPAA guidelines, privacy practices, patient confidentiality, and patient rights
    • Schedule patient appointments or tests/procedures by interpreting physician orders, by patient need, or by established protocols. Provide patient with instructions or preparation for the test/procedure.
  • Technical
    • Demonstrated knowledge of medical terminology.
    • Responsible for referral coordination and troubleshooting scheduling and referral issues for patients with multiple departments.
    • This position manages complex appointment scheduling linking clinical visits, consults and ancillary services
    • Obtains accurate patient information necessary for medical records, governmental requirements, billing, and third-party payer needs.
    • Electronically validates medical, demographic, insurance and financial data in a timely and courteous manner.
    • Explains pre-appointment preparation requirements
    • Provides patient education about coverage and liabilities; communicates possible payment obligations and personally connects patients to a financial counselor if needed
    • Demonstrated reading skills to interpret instructions, manuals, insurance information, physician instructions and patient correspondence.
  • Organizational
    • Establishes files, maintains information, and scans medical records in a timely and organized manner
    • Processes multi-channel messages related to patient and/or physician requests regarding appointments, referrals, prescriptions, and complaints.
    • Accurately performs medical record maintenance and releases
    • Scan necessary documents into electronic health record
    • Maintains accountability for accuracy of data collected and entered into systems.
    • When needed, checks and confirms patient benefits prior to scheduling
  • Performs other duties as assigned.
EXPECTED BEHAVIORS:

Attitude/Customer Competencies
  • Caring, compassionate, and approachable in all customer contacts
  • Privacy - respects customers' right to privacy and modesty
  • Confidentiality - maintains customers' confidentiality
  • Telephone etiquette - speaks so that customers hear a smile
  • Appearance - takes personal ownership of appearance and that of work environment
  • Initiative - takes necessary steps to fix problems immediately
  • Providing Direction and Customer Acknowledgment - provides personalized attention by being courteous, friendly, and helpful when responding to customers' needs
  • Timely service - recognizes that customers' time is very valuable; provides them with prompt service
  • Customer information/education - provides customers with the best information needed to make informed choices
Relationship Competencies/Work Group Competencies
  • Demonstrates advocacy, respect and truth telling
  • Demonstrates accountability for own actions
  • Demonstrates the ability to respectfully address interpersonal conflicts
  • Takes initiative to help others
  • Demonstrates a learning attitude toward solving problems
  • Demonstrates openness to change and new learning
  • Reports to work on time and has regular attendance
  • Adheres to practice defined dress code
  • Attends staff meetings
Ethical Decision-Making
  • Respects the needs, expectations and rights of all individuals
  • Advocates the rights of all to a safe environment
  • Uses sensitivity to cultural diversity to guide decision-making
Position Requirements

CERTIFICATION/LICENSE: RN license Required.

Successful completion of the CHAM (Certified Healthcare Access Manager) Certification course - NAHAM within 6 months of hire.

ADDITIONAL LICENSURE / CREDENTIAL REQUIREMENTS:

An associate or bachelor's degree in nursing or a related field required.

EDUCATION AND EXPERIENCE REQUIREMENTS: Mandatory Continuing Education: Customer Service, Fire and Safety, Corporate Compliance (including Confidentiality), Infection Control, and education required by regulatory, accreditation bodies, scope of practice, and/or Hancock Regional Hospital.
  • 2-3 years' experience with pre-cert, referrals and authorization processes strongly preferred
  • Knowledge of medical office practices and procedures.
  • Excellent written and verbal communication skills
  • Proficiency in Microsoft suite (Outlook, Word, Excel, PowerPoint) is preferred
  • Demonstrated ability to use PCs (and toggle between multiple applications), MS Office, and general office equipment (i.e., printers, scanners, electronic signature pads, copy machine, multi-line phone, etc.) required.
  • Excellent keyboarding/data entry skills required
  • Comprehension of department-specific associate duties and processes.


Full-Time/Part-Time
Full-Time

Shift
Days

Resubmittal due to closure after 120 days open?

Number of Openings

Exempt/Non-Exempt

Position
Authorization Specialist (767)

Number of Openings
1

Exempt/Non-Exempt
Non-Exempt

Open Date
7/3/2024

Location
Network Navigation

About the Organization
YOUR HEALTH IS OUR LIFE

Hancock Health is an Indiana-based, full-service healthcare network serving Hancock County and the surrounding areas. Our health system includes Hancock Regional Hospital, Hancock Physician Network and more than 20 other healthcare facilities, such as wellness centers, women's clinics, family practices, and the Sue Ann Wortman Cancer Center.

A Caring Community Partner
Our goal at Hancock Health is simple: To give every person the personalized attention necessary for a happy, healthy life. Our mission, vision, and values embody this goal.

OUR MISSION
To be a Caring Community Partner by healing, improving health and wellness, alleviating suffering, and delivering acts of kindness one person at a time.

OUR VISION
To be nationally recognized for kindness in the delivery of excellent quality patient care, efficient and effective operations, the adoption of proven technologies, the creation of a positive workplace environment, and excellence in community service.

OUR VALUES
Exceptional | Honorable | Devoted | Reliable | Kind

EOE Statement
We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.

This position is currently accepting applications.