Authorization Specialist II

2 weeks ago


Charlottesville, Virginia, United States Sentara Full time
Location: Norfolk, VA

Overview:
Sentara Martha Jefferson Hospital is seeking an Authorization Specialist II for a full-time day schedule. Our hospital, established in 1903, has a long-standing commitment to delivering high-quality clinical care and personalized healthcare services. We pride ourselves on providing a welcoming environment with all private patient rooms.

Benefits:

Sentara offers a comprehensive benefits package for full-time employees, including Medical, Dental, Vision, Paid Time Off, Sick Leave, Tuition Reimbursement, a 401k/403B plan, 401a, Performance Plus Bonus, and numerous opportunities for career advancement. Our supportive, family-oriented culture promotes community engagement and fosters professional growth.

Join a dedicated healthcare organization that prioritizes our People, Quality, Patient Safety, Service, and Integrity. Be part of a team committed to enhancing health every day and striving to be the preferred healthcare provider in our communities.


Job Summary:

The Authorization Specialist II is responsible for evaluating clinical information sourced from physicians and other clinical providers to ensure it meets the necessary criteria for service authorization across various visit account types. This role involves:

  • Analyzing clinical data to confirm that requested services are authorized in accordance with clinical and payer guidelines.
  • Obtaining insurance eligibility, member benefits, and securing authorizations while completing pre-registration for requested services.
  • Validating the accuracy of active insurance enrollment prior to service authorization.

The specialist will also assist in covering for team members during staff shortages and will play a key role in managing team projects. Collaboration with educational and leadership teams to identify opportunities for improvement and implement solutions is essential.


Key Responsibilities:
  • Conduct thorough assessments and reviews of patient treatment plans, including care location and duration.
  • Stay informed on payer authorization and benefit policies to ensure compliance.
  • Demonstrate critical thinking and collaborate effectively with peers and leadership to support team objectives and achieve positive outcomes as measured by key performance indicators.
  • Provide excellent customer service to all stakeholders, including patients, peers, and department leadership.
  • Act as a liaison among patients, physicians, clinical departments, and insurance providers.

Knowledge of medical terminology and ICD-10 coding is required. The specialist will handle semi-complex authorization tasks based on payer behavior and time constraints, necessitating problem-solving skills and the ability to investigate and resolve issues related to work assignments.


Qualifications:
  • High School Diploma or equivalent.
  • Certification as a Healthcare Access Associate (CHAA) or Healthcare Access Manager (CHAM) from the National Association of Healthcare Access Management (NAHAM).
  • Experience in Health Insurance Authorizations, Verification, and Registration/Billing.

Sentara Healthcare values diversity and inclusiveness within its workforce, which comprises nearly 30,000 members. We are committed to ensuring our workforce reflects the communities we serve.

In alignment with our mission to improve health every day, we maintain a tobacco-free environment.



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