Authorization Specialist II

2 weeks ago

Charlottesville, Virginia, United States Sentara Healthcare Full time
City/State
Charlottesville, VA

Overview

Work Shift
First (Days) (United States of America)

Sentara Martha Jefferson Hospital is seeking an Authorization Specialist II - Full Time Day schedule

Qualifications:
High School Diploma or Equivalent is required.

Experience in Health Insurance Authorizations, Health Insurance Verification, or Registration/Billing is necessary - a minimum of 2 years.

Knowledge of medical terminology and ICD-10 is essential.

Sentara Martha Jefferson Hospital, established in 1903, is dedicated to delivering high-quality clinical care and personalized healthcare services. The facility features 176 patient-friendly private 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, 401a, Performance Plus Bonus, and opportunities for Career Advancement.
Our culture promotes family-friendly values, community engagement, and endless opportunities for personal and professional growth.

Join a reputable healthcare organization that prioritizes its People, Quality, Patient Safety, Service, and Integrity. Be part of a team committed to enhancing health every day and serving the communities effectively.


Job Summary


The Authorization Specialist II is responsible for evaluating clinical information from physicians and other clinical providers to ensure sufficient data is available to authorize services for the appropriate visit account types.
Key responsibilities include analyzing clinical data to confirm that requested services are authorized in accordance with clinical and payer protocols. The role requires proficiency in obtaining insurance eligibility, member benefits, securing authorizations, and completing pre-registration for requested services.
Additionally, validating the accuracy of active insurance enrollment in the system prior to authorizing services is crucial.

Team collaboration is essential, as the specialist may assist colleagues during staff shortages or increased workloads as directed by leadership.
Managing team projects and working with education and leadership to identify opportunities for improvement and implement solutions is also part of the role.

Accurate assessment and review of patient treatment plans, including care location and duration, are required.
Critical thinking and positive collaboration with peers and leaders are necessary to support team objectives and achieve positive results, as demonstrated through key performance indicators.

Staying informed about payer authorization and benefit policies is a must.
The specialist must understand complex payer policies and treatment plans to secure timely authorizations with the correct documentation and in compliance with payer requirements.

Exceptional customer service skills are required for interactions with patients, peers, department team members, and leadership. Acting as a liaison between patients, physicians, clinical departments, and insurance companies is a key aspect of the role.

The specialist will handle semi-complex and challenging authorization tasks based on payer behavior and time requirements. Problem-solving, investigation, and resolution of issues related to work assignments are expected.

Effective collaboration with internal and external teams is necessary to achieve desired outcomes as determined by key performance indicators and leadership.

Qualifications:

High School Graduate or Equivalent

Certifications: Certified Healthcare Access Associate (CHAA) and Certified Healthcare Access Manager (CHAM) from the National Association of Healthcare Access Management (NAHAM) are preferred.

Experience in Health Insurance Authorizations, Health Insurance Verification, and Registration/Billing is essential.

Skills

Sentara Healthcare values diversity and inclusiveness within its workforce, which comprises nearly 30,000 members.

Diversity, inclusion, and belonging are fundamental principles that ensure the workforce reflects the communities served.

In compliance with Clinical Laboratory Improvement Amendments (CLIA), certain clinical environments may require proof of education; further information is available through official channels.

To expedite the verification process, applicants are encouraged to upload their diploma or transcript at the time of application.

Sentara Healthcare maintains a tobacco-free environment in support of its mission to improve health every day.

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