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Surgical Authorization Specialist

2 months ago

Fairhaven Massachusetts, United States Southcoast Health System, Inc. Full time

Overview:
Discover why Southcoast Health has been recognized as a top workplace for six consecutive years.

At Southcoast Health, we believe in a future filled with promise, just as we provide exceptional care to our patients.

Our dedication to each other, our patients, and our community transcends mere mission statements; it is the essence of our daily operations.


As a not-for-profit, charitable health system, Southcoast Health operates multiple hospitals, clinics, and facilities across Southeastern Massachusetts and Rhode Island.


Rooted in local communities, we foster inclusive and ethical work environments where our skilled healthcare professionals deliver comprehensive, world-class medical services close to home.

We are seeking a dedicated Surgical Authorization Specialist.

Hours:
Per Diem

Shift:
Day shift with weekend and one minor vacation per year rotation

Location:
Southcoast Business Center – Fairhaven, MA

Benefits of a career at Southcoast Health include:
A culture that promotes well-being, embraces diversity, and honors the communities we serve.

Competitive compensation and a comprehensive benefits package.

Generous Earned Time Off policy.

Employee Wellbeing Program.

403B Retirement Plan with company matching.

Tuition assistance and Federal Loan Forgiveness programs.

Opportunities for professional development and tailored leadership training.

Eligibility for regular status employees scheduled for a minimum of 24 hours.

Southcoast Health is an Equal Opportunity Employer.

Key Responsibilities:
This position reports to the Team Leader or designated representative. The role encompasses a variety of tasks aimed at optimizing revenue for services rendered at Southcoast facilities.

Responsibilities include entering orders, scheduling, canceling, and rescheduling appointments, assessing patient liability prior to service by generating estimates based on individual payers, informing patients of their potential financial responsibilities in compliance with Federal and State regulations, and collecting payments electronically.

Initiate communication with patients, physicians, and third-party payers to secure pre-certification and authorization for all inpatient and outpatient services. Act as a liaison between third-party payers and providers, facilitating peer-to-peer discussions to authorize surgical and high-cost services. Employ critical thinking skills to ensure accurate documentation and authorization of CPT codes for relevant services. Collaborate with Care Coordination to determine and authorize the appropriate level of care. Navigate various payer portals to ascertain authorization requirements and submit electronic requests. Work with Pharmacy to identify suitable infusion medication sources and obtain necessary authorizations for medications and services. Address payer denials by researching clinical data to support appeals. Verify coverage and initiate authorization for new patients entering the SE Rehab Department.

Qualifications:
An Associate's Degree in a related field or an equivalent combination of education and experience is required; a Bachelor's Degree is preferred.

A Certificate in Medical Terminology is preferred.

Coding experience is advantageous.

Strong typing skills with a minimum typing speed of 40 words per minute.

Demonstrated exceptional customer service abilities.

Effective communication skills with physicians, patients, and third-party payers.

Proficient in navigating multiple payer portals and web-based tools.

Over three years of healthcare experience focusing on revenue cycle activities is preferred.

Medical Terminology Certificate is preferred.


Must be fully vaccinated against seasonal Influenza and the COVID-19 virus or be exempt from the requirement for medical or personal reasons by signing a statement certifying the choice to be exempt from vaccination upon hiring.


Pay Range:
USD $30.89 /Hr.

Rotation Schedule Requirement:
One minor vacation per year