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Clinical Authorization Specialist
2 months ago
The Clinical Authorization Specialist plays a crucial role in the healthcare process by ensuring that precertification is accurately completed for patients as mandated by insurance providers.
This position involves a variety of administrative responsibilities that support both clinical and provider needs.
Key Responsibilities:
- Secure necessary approvals by investigating ICD-10 coding, completing required authorization documents, and ensuring that clinical details are communicated to insurance companies.
- Collaborate with staff to exchange information and receive updates regarding patient conditions or procedures.
- Act as a resource for staff, providing education on the precertification process.
- Work alongside Patient Accounts to address billing and precertification challenges, supplying necessary documentation as required.
- Verify all self-pay accounts and conduct thorough research to confirm the absence of other insurance coverage.
- Develop proficiency in current technologies, including electronic medical records and other relevant systems.
- Maintain electronic files, logs, and records for efficient retrieval and accurate tracking of production.
- Ensure confidentiality concerning employee, legal, client/patient, budget, and all company-related matters.
- Prepare visit charts based on daily appointments, ensuring all necessary medical records are accessible to providers.
- Document information using clear, concise, and professional writing skills.
- Process medication prescription refills in accordance with established guidelines.
- Communicate with patients in a timely and professional manner, addressing complaints or negative feedback appropriately.
- Identify urgent situations and notify the appropriate personnel for intervention.
- Engage in quality and regulatory activities, fostering teamwork and professional relationships within the organization.
- Participate in continuing education to enhance personal knowledge and skills.
- Cross-train as a patient service representative as needed.
Qualifications:
Education:
A High School diploma or GED is required. Completion of an accredited Medical Assistant program or equivalent clinical experience in a healthcare-related field is essential.
Licensure:
Medical Assistant certification is preferred.
Experience:
A minimum of one year of experience as a Medical Assistant or in a similar clinical role is preferred. Experience in customer service and/or office settings is also advantageous.
What SolutionHealth Offers:
- Comprehensive health, dental, prescription, and vision coverage for both full-time and part-time employees.
- Short-term and long-term disability insurance, along with life insurance coverage.
- Competitive compensation packages.
- Tuition reimbursement programs.
- 403(b) Retirement Savings Plan.
- And additional benefits.
Work Schedule:
Monday to Friday, 8 AM to 5 PM, totaling 32 hours weekly.
SolutionHealth is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, disability status, veteran status, or any other characteristic protected by law.