Authorization Specialist

2 hours ago


Corona, California, United States KPC Global MSO Full time
Job Summary

We are seeking a highly skilled Authorization Specialist to join our team at KPC Global MSO. The successful candidate will be responsible for ensuring timely verification and validation of authorizations for all Commercial and Managed care inpatients and other services as assigned.

Key Responsibilities
  • Verify and validate authorizations for all Commercial and Managed care inpatients and other services as assigned.
  • Contact insurance companies via phone or website to secure authorization.
  • Review all discharged managed care patients for evidence of authorization entry in the Authorization module.
  • Obtain missing authorizations within 3 business days of patient's discharge or in some cases within 7 days of admission.
  • Check bill hold weekly for pending authorizations.
  • Assist with sending delinquent reviews and resending reviews not received by the Payors.
  • Communicate effectively with Case Management and all departments that have direct or indirect impact on obtaining authorizations.
  • Maintain analysis of authorization issues, by payer.
  • Report monthly summary for authorization issues to senior leadership.
  • Document all contacts and authorization information for all types of authorizations in the hospital system.
Requirements
  • Follow established hospital policies and procedures regarding authorization processes.
  • Other duties as assigned.

The posted pay scale represents the range the Company reasonably expects to pay candidates for this position. The actual wage for this position may depend on factors such as experience and education, specific skills and abilities, alignment with similar internal candidates, marketplace factors, and Company business practices.



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