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Specialist - Authorization
1 month ago
Summary
Coordinates precertification/authorization services for patients across the continuum of care, promoting quality care, and effective utilization of resources. Provides leadership when dealing with patient preauthorization functions, including inpatient and outpatient services. Coordinates efforts between departments to ensure accurate precertification, resulting in timely billing of claims. Some overtime and call back may be required. Performs other duties as assigned.
Responsibilities
- Precertifies patient care services that require precertification, in a timely, efficient manner, in order to optimize reimbursement for the patient as well as healthcare providers.
- Communicates recommendations, clinical information, and fiscal information to appropriate internal and external customers in order to facilitate optimal delivery of services and customer satisfaction.
- Reviews orders for accuracy and medical necessity to facilitate delivery of services and appropriate reimbursement.
- Addresses issues identified with retrospective reviews for all payers.
- All outpatient procedures will be timely precerted when applicable.
- Works to improve the QI/PI process.
- Assumes responsibility for personal growth and development by attendance and/or participation in inservices and continuing education programs.
- Completes assigned goals.
Requirements, Preferences and Experience
Education
- Preferred: Associates degree in related field
- Minimum: Knowledge of medical terminology
Experience
- Preferred: Prefer experience in a clinic setting as well as dealing with prior authorizations.
- Minimum: 2 years of office and/or clinical experience.
Licensure, Registration, Certification
- Preferred: LPN
Special Skills
- Minimum: Advanced communication, conflict management, organizational and planning skills; advanced computer literacy skills.
About Baptist Memorial Health Care
At Baptist, we owe our success to our colleagues, who have both technical expertise and a compassionate attitude. Every day they carry out Christ's three-fold ministry-healing, preaching and teaching. We reward their efforts with compensation and benefits packages that are highly competitive in the Mid-South healthcare community.
At Baptist, We Offer:
- Competitive salaries
- Paid vacation/time off
- Continuing education opportunities
- Generous retirement plan
- Health insurance, including dental and vision
- Sick leave
- Service awards
- Free parking
- Short-term disability
- Life insurance
- Health care and dependent care spending accounts
- Education assistance/continuing education
- Employee referral program
