Authorization Specialist
2 days ago
Why work at TidalHealth?
Looking for a rewarding place to work? Choose TidalHealth. U.S. News & World Report, a global authority in hospital rankings and consumer advice, has named TidalHealth Peninsula Regional and TidalHealth Nanticoke as 2022-2023 High Performing hospitals for 11 challenging and elective health conditions; the highest award a hospital can earn for U.S. News' Best Hospitals Procedures & Conditions ratings. Located just 30 minutes from the beach, TidalHealth offers the widest array of specialty and subspecialty services such as neurosurgery, cardiothoracic surgery, joint replacement, emergency/trauma care, comprehensive cancer care, wound care and clinical trials and research. Take advantage of our tuition assistance and scholarship programs to grow both personally and professionally.
Authorization Specialist Position Summary
The Authorization Specialist is responsible and accountable for monitoring and submitting all insurance authorizations including but not limited to; prior service, surgical, acute hospital, and post-acute care authorizations, that may include rehabilitation, transportation, medication, durable medical equipment, and home service authorizations that align with medical necessity policies and regulatory requirements for TidalHealth. The Authorization Specialist works collaboratively with Case Managers, Utilization RNs, physician advisors, insurance companies, finance, patients, providers, and authorization process stakeholders, to reduce length of stay, ensure fiscal responsibility, appropriate use of benefits, and streamlining the discharge process. They will also be responsible for maintaining and following up on non-clinical administrative tasks related to utilization review, discharge planning, PCP appointments, regulatory paperwork, invoicing, prior authorizations, benefit verification preservice review, healthcare claims inquiry, appeal/denial tracking, and case documentation.
Authorization Specialist Position Requirements
Education:
- Bachelor's degree in a health-related field or equivalent medical office experience is required.
- Minimum of three (3) years clinical/medical office and/or related experience required.
- Working knowledge of Microsoft applications, primarily Excel, Outlook and Word is required.
- Experience utilizing EMR systems (EPIC preferred).
- Working knowledge of ICD Diagnostic Codes and medical terminology.
- Primarily day shift, Monday through Friday
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