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Patient Authorization Specialist

2 months ago

West Allis, Wisconsin, United States Advocate Health Full time

Position Overview

The role of the Patient Authorization Specialist involves managing, confirming, and securing the necessary referrals, authorizations, or pre-certifications essential for patients to access medical services. This position requires a thorough verification of patient account details to ensure accuracy and completeness.

Key Responsibilities

  • Maintain a comprehensive database of payer authorization requirements.
  • Ensure that all information collected is complete and accurate, utilizing knowledge of Medicare, Medicaid, and various third-party payer systems.
  • Engage with insurance providers to ascertain benefit coverage, policy limitations, and necessary authorizations for patients.
  • Follow up with healthcare providers, financial counselors, patients, and insurance companies to finalize the pre-certification process.
  • Collaborate with internal departments to provide updates on account statuses, resolve issues, and appeal any denied authorizations.
  • Educate patients, staff, and healthcare providers on referral and authorization requirements, coverage guidelines, and documentation necessities.
  • Ensure that all services receive prior authorizations and keep patients informed about their pre-authorization status.
  • Coordinate peer-to-peer reviews as mandated by insurance policies.
  • Notify relevant parties of any lapses in insurance coverage or changes in patient status.
  • Maintain organized files for referral and insurance documentation and input referrals into the system.

Qualifications

Education: High School Diploma or equivalent.

Experience: Typically requires a minimum of one year in customer service, particularly in patient accounts, third-party payer plans, and medical clinic workflows.

Skills: Proficient understanding of third-party payer requirements and pre-authorization processes. Familiarity with medical terminology and human anatomy is essential. Intermediate skills in Microsoft Office applications, electronic mail, and medical records systems are required. Strong analytical, organizational, and communication skills are necessary, with the ability to manage multiple priorities independently.

Work Schedule

This position offers a full-time or part-time opportunity with a commitment to in-office training.