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Full Time
Job Summary : The Authorization Specialist II ensures accuracy of insurance information and obtains prior authorization and predetermination requirements for non-oncology infusions, oncology infusions, and radiation oncology.
This role navigates highly detailed processes including treatment plans, National Comprehensive Cancer Network (NCCN) guidelines, medical necessity reviews, authorization submissions and follow-up care.
The Authorization Specialist II maintains exceptional customer service, promotes the teamwork, and reflects the goals, values, and mission of the health system.
Minimum Education : High School Diploma or GED.
Licensure, Registration and / or Certification : None.
Work Experience : Minimum 2 years of benefits verification or authorization experience or 3 years of pre-registration experience.
Post -secondary education may be substituted for 2 years of experience.
Knowledge, Skills and Abilities : Basic healthcare knowledge and insurance terminology including medical billing and insurance follow-up processes.
PC and basic software skills. Proven keyboard skills with the ability to type 75 WPM. Excellent oral and verbal communication skills.
Ability to navigate insurance websites to access patient eligibility and payment information. Ability to organize and prioritize work and the ability to be detail oriented.
Ability to interact with physicians, physician offices and all levels of team members within the health system.
Essential Functions and Responsibilities : Monitors patient, referrals, and denials work queues to determine encounters that require pre-registration, verification, authorization, or corrections to ensure proper billing.
Works encounters according to assignment and consistently meets daily and weekly productivity goals. Evaluates physician orders and pre-screens for medical necessity;
notes frequency and duration of treatment plan and communicates directly with ordering provider or clinical staff to facilitate order revisions as indicated.
Reviews clinical documentation for Current Procedural Terminology (CPT) and diagnosis code information to support authorization and precertification according to payer guidelines.
Monitors, reviews, and processes authorizations and validates the requests are accurate, within the required timeline, and in compliance with the applicable insurance guidelines.
Consults with pharmacy team members regarding provider ordered drugs in relation to payer preference to identify appropriate codes for authorization submission and to establish the appropriateness of the treatment regimen in alignment with NCCN and payer guidelines.
Confers with pharmacy or clinical partners to facilitate additional information when required by payer. Coordinates with patient, referring physician's office, referring location, scheduled service area, financial counselors, case manager, and others, as appropriate to obtain additional information or provide information on patient financial status.
Documents pertinent information and efforts in computer system based upon department documentation standards. Protects the privacy and security of patient health information to ensure that confidentiality is maintained.
Decision Making : Independent judgement in planning sequence of operations and making minor decisions in a complex technical or professional field.
Working Relationships : Works directly with patients and / or customers. Works with internal and / or external customers via telephone or face to face interaction.
Works with other healthcare professionals and staff.
Supplemental Information : This document generally describes the essential functions of the job and the physical demands required to perform the job.
This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.
Pre-Arrival - Yale Campus
Location : Tulsa, Oklahoma 74136
EOE Protected Veterans / Disability
Last updated : 2024-06-23
Full Time
$62k-76k (estimate)
06/24/2024
06/25/2024
mediabistro.com
New York, NY
100 - 200
The job skills required for Authorization specialist include Planning, Confidentiality, Customer Service, Decision Making, Prior Authorization, Verbal Communication, etc. Having related job skills and expertise will give you an advantage when applying to be an Authorization specialist. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Authorization specialist. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Authorization specialist positions, which can be used as a reference in future career path planning. As an Authorization specialist, it can be promoted into senior positions as a Medical Policy Manager that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Authorization specialist. You can explore the career advancement for an Authorization specialist below and select your interested title to get hiring information.
If you are interested in becoming an Authorization Specialist, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become an Authorization Specialist for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on Authorization Specialist job description and responsibilities
Updates patient insurance and demographics information as needed.
03/31/2022: Florence, SC
Request, follow up and secure prior-authorizations prior to services being performed.
03/30/2022: Rochester, NY
Complete authorizations and referrals for services, including appointments and procedures.
01/29/2022: Clarksville, TN
Monitors incoming patient orders and gathers information needed to complete the pre-authorization and scheduling of an order
03/22/2022: Ann Arbor, MI
Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
01/29/2022: York, PA
Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on Authorization Specialist jobs
There are great benefits to having a Prior Authorization Certified Specialist on staff to help with the administrative process.
03/31/2022: Greensboro, NC
Give credence to customer complaints.
02/08/2022: Salem, OR
Create a quick reference guide of your payor contacts
04/11/2022: Cincinnati, OH
Authorization Specialist assist with other clerical tasks as needed.
01/22/2022: Lincoln, NE
Licenses and certifications are not usually required to work as a prior authorization specialist.
03/09/2022: Bremerton, WA
Step 3: View the best colleges and universities for Authorization Specialist.