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Nursing Authorization Specialist

2 months ago

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

Position Overview:

ROLE SUMMARY: The Authorization Specialist plays a vital role within the Network Navigation department, acting as a key resource for both the Authorization Advocate and patients. This position is tasked with addressing more intricate pre-certification, authorization, and referral requirements. The specialist collaborates with healthcare providers, insurance companies, and Authorization Advocates to resolve patient inquiries and issues. Furthermore, this role provides support during peak times or when the Authorization Advocates face scheduling challenges.

KEY QUALIFICATIONS:

CORE COMPETENCIES:
  • Customer-Centric Approach: The Authorization Specialist must exhibit a strong commitment to customer service, prioritizing patient needs.
  • Effective Communication: This role requires exceptional written and verbal communication skills, alongside a solid understanding of medical terminology, to interact effectively with patients and healthcare staff.
  • Organizational Proficiency: Strong administrative and organizational capabilities are essential for managing responsibilities efficiently.
  • Detail-Oriented: The ability to multitask while maintaining a keen attention to detail and strong analytical skills is crucial.
  • Technical Expertise: Proficiency in Microsoft Office applications is necessary; familiarity with Meditech is advantageous but not mandatory.
  • Ability to work independently and collaboratively in a dynamic environment.
PRIMARY RESPONSIBILITIES:
  • Independently retrieve orders from designated worklists.
  • Verify provider orders, authorizations, and locations, ensuring accuracy.
  • Access insurance databases to obtain prior authorizations and pre-certifications.
  • Maintain precise chart documentation in accordance with departmental protocols and insurance regulations.
  • Efficiently process referrals and pre-certifications, including the collection of detailed medical records and patient communication regarding referral status.
  • Maintain ongoing communication with specialty offices to confirm patient scheduling.
  • Collaborate with other specialists and advocates on process enhancement initiatives.
  • Accurately input clinical and non-clinical information into patient records.
  • Serve as a clinical resource for the Authorization Advocates and the broader Network Navigation team.
  • Ensure patient confidentiality in compliance with applicable regulations.
  • Validate insurance coverage according to established procedures.
  • Perform additional duties as assigned by management.
EXPECTED BEHAVIORS:

Customer Service Competencies:
  • Demonstrates compassion and approachability in all interactions.
  • Maintains confidentiality and respects patient privacy.
  • Exhibits professionalism in communication and service delivery.
  • Proactively addresses patient needs and inquiries.
Position Requirements:

CERTIFICATION/LICENSE: Valid RN license is required.

Successful completion of the CHAM (Certified Healthcare Access Manager) Certification course is expected within six months of hire.

EDUCATION AND EXPERIENCE: An associate or bachelor's degree in nursing or a related field is required.

2-3 years of experience in pre-certification, referrals, and authorization processes is preferred.

Proficiency in Microsoft Office applications is necessary.

Demonstrated ability to manage multiple tasks and maintain accuracy in a fast-paced environment.