Authorization Specialist

United States·Noblesvillemid

OtherAuthorization Specialist

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Quick Summary

Overview

Job Summary The Authorization Specialist is responsible for ensuring that payers are prepared to reimburse Riverview Health for scheduled services in accordance with the payer-provider contract.

Technical Tools

OtherAuthorization Specialist

Responsibilities

~1 min read

→Verifies patients’ insurance and benefits information
→Obtains prior authorizations from third-party payers in accordance with payer requirements. Identifies patients who will need to receive Medicare Advance Beneficiary Notices of Noncoverage (ABNs).
→Contacts patients to gather demographic and insurance information as needed, and updates patient information within the EMR as necessary.
→Works with other departments to gather the clinical information required by the payer to authorize services. Maintains accurate records of authorizations within EMR.
→Develops price estimates for patient out-of-pocket responsibility.
→Refers accounts to financial counseling as needed if authorization is not obtained. Works with business office staff to support appeal efforts for authorization-related denials.
→Reviews surgery schedules to ensure Medicare patients with IP-only procedures have the appropriate authorization and order.
→Complies with HIPAA regulations, as well as Riverview Health policies and procedures regarding patient privacy and confidentiality.
→Maintains professional tone at all times when communicating with patients and payer representatives.
→Coordinates re-education to practices or hospital departments when orders are incorrect or not supported by the given diagnosis.
→Performs other duties as requested.

Requirements

~1 min read

Minimum: Associate degree in healthcare or business administration and/or related coursework, or comparable experience
Preferred: Experience in Epic

Minimum: Two years of experience in a healthcare setting performing related tasks
Preferred: Five years of experience in a healthcare setting performing related tasks