Authorization Specialist II, RCM

United States·Phoenixmid

OtherAuthorization Specialist

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Quick Summary

Key Responsibilities

Checking eligibility/benefits on patients as needed: Upon intake if not previously done for all patients, monthly on patients with non-Medicaid insurances,

Requirements Summary

“You are not required to disclose information about physical or mental limitations that you believe will not interfere with your ability to do the job. However,

Technical Tools

OtherAuthorization Specialist

The Authorization Specialist II, RCM is a position that performs the authorization requests for all insurances. In this role, you will report to the Authorization Manager, RCM.

Responsibilities

~1 min read

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Checking eligibility/benefits on patients as needed: Upon intake if not previously done for all patients, monthly on patients with non-Medicaid insurances, and at the beginning of each month where prior authorization is not required
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At the beginning of every new year, obtaining details on eligibility, patients deductible and out of pocket costs
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Communicating any patients that will have a patient responsibility with the appropriate staff so they can verify the patient will want services and to inform field staff to correctly fill out the consents
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Tracking and obtaining all authorizations for all locations, along with reauthorization throughout duration of patient care
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Data entering all authorization information into the system
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Verifying accuracy in payor setup in EMR for all active policies
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Maintain electronic record of all authorizations
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Run reports daily, weekly, and monthly for department
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Communicate with both internal and external customers to ensure authorizations are utilized accurately
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Determine through eligibility and payer knowledge if the company can service a patient
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Appeal denials as required by payer, including appeals through the health commission or applicable governing body
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Attend regular meetings with branches as needed to ensure open communication
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Perform other duties as assigned

Excellent verbal and written communication skills with ability to communicate across all levels of authority within company
Excellent organization, problem solving, and project management skills
Able to independently file appeals with multiple payors
Troubleshoot eligibility issues with internal teams as it relates to insurance coverage
Able to effectively deal with change
Understand the patients benefits throughout the patient admission
Able to complete projects within specific timetables
Able to successfully interact with people in face-to-face situations as well as by telephone in a professional and effective manner

High school or GED diploma required
Minimum of two years’ experience in health-related authorization and eligibility required

Requirements

~1 min read

“You are not required to disclose information about physical or mental limitations that you believe will not interfere with your ability to do the job. However, you should disclose any physical or mental impairment for which special arrangements or accommodations are needed to enable you to perform the essential functions of the job. Your description of any impairment and suggestions for reasonable accommodations will be considered in providing reasonable accommodations.”

Requires the ability to write, dictate or use a keyboard to communicate directives
Utilizes proper body mechanics in multiple environments
Requires the ability to function in multiple environments

FLSA Status: Non-exempt

EEO Status: Administrative Support Workers