Insurance Authorization Specialist

1 week ago

Cleveland, Ohio, United States Cleveland Clinic Full time
Overview:

At Cleveland Clinic, we understand that exceptional care is a collaborative effort. We are seeking an Authorization Representative to engage with external insurance providers to ensure compliance with prior authorization protocols established by payers.

This position involves confirming benefits and submitting requests for prior authorization, playing a vital role in process enhancement initiatives through Kaizen methodologies, and spearheading engagement efforts within the department.

This role serves as a robust introduction to potential career advancement within the department, including positions such as Representative Level I and III, Administrative Program roles, Quality Assurance, Program Manager, and formal leadership roles like Work Leader, Supervisor, Manager, and Senior Manager.

The ideal candidate will be a quick thinker with a solid understanding of healthcare terminology, experience in authorization processes (pre- or post-service), technological proficiency, and the ability to thrive in a continuous improvement environment. Attention to detail is crucial, as is the capability to navigate non-standard industry experiences with payers while managing tight scheduling demands and increasing volumes.

What We Offer:

At Cleveland Clinic, we prioritize our caregivers as if they were family. We continuously strive to provide resources for learning and growth, a rewarding career for everyone, and comprehensive benefits that support your health, well-being, and future.

When you become part of Cleveland Clinic, you will join a supportive caregiver community united by shared values and a commitment to being the best place for care and employment in healthcare.

Key Responsibilities:
  • Cross-train to support all areas of Authorization across various facilities, including verification, pre-certification, eligibility, and benefits such as copays, deductibles, and out-of-pocket expenses.
  • Identify accounts requiring high dollar financial clearance.
  • Utilize appropriate reports to engage with insurance payers for resolution of accounts that are pending, denied, or in the appeal process.
  • Maintain productivity and quality standards as set by the department.
  • Perform registration input to ensure accurate patient information for the authorization process.
  • Communicate with physician offices to obtain clinical information and coordinate peer-to-peer discussions.
  • Execute other duties as assigned.
Qualifications:

Education: High school diploma or equivalent required.

Certifications: None required.

Experience: Minimum of 2 years in a customer-facing role with in-person or phone contact. Proficiency in PC skills is essential. Ability to multitask across multiple accounts in a high-volume insurance verification environment is necessary. An Associate's degree may substitute for up to one year of experience, while a Bachelor's degree may substitute for up to two years.

Physical Requirements:

Ability to communicate and exchange accurate information. Capability to perform work in a stationary position for extended periods. Ability to work with physical records or operate a computer or other office equipment. Some locations may require travel throughout the facility and the ability to lift up to 25 lbs.

Personal Protective Equipment:

Adhere to Standard Precautions using personal protective equipment.

Compensation:

Pay Range: Minimum hourly: $15.75, Maximum hourly: $21.65. The displayed pay range reflects the anticipated range for new hires. Actual compensation will be determined based on factors such as work history, experience, skill set, and education. This does not include the value of Cleveland Clinic's benefits package, which encompasses healthcare, dental, vision, and retirement options.

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