Authorization Specialist

Responsible for performing all tasks associated with the prior authorization process. Coordinate with/educate physicians, nursing staff and other health care providers on the authorization process and requirements. Works as a patient advocate and functions as a liaison between the patient, staff and payer to answer reimbursement questions and avoid insurance delays. Tracks, documents, and monitors authorizations. Implements check and balance systems to ensure timely compliance.

Essential Job Functions
GENERAL
•Supports and models behaviors consistent with Billings Clinic’s mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance.
Supports and models behaviors consistent with Billings Clinic’s mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance.

Performs all other duties as assigned or as needed to meet the needs of the department/organization.
•Coordinates authorization process ensuring authorization has been accurately obtained in a timely manner, collecting all necessary documentation, including contacting the patient for additional information if necessary.
•Proactively Identifies and initiates authorization requirements for individual payers and communicates with payer sources in a timely manner to obtain necessary authorization.
•Documents and maintains patient authorization data within Cerner. Documents and tracks authorizations using established process.
•Reports denials and/or delays in authorization process to physicians/other health care providers and/or the patient.
•Develops and maintains collaborative working relationships with payers, patient financial services, MAP, Specialty Pharmacy and health care team.
•Reports non-compliance issues to department specific leadership team.
•Tracks and verifies that authorization has been received either verbally or written, and documents authorization verification into Cerner.
•Communicates status to health care team and patient as needed. Reviews schedules and work lists throughout the day.
•Makes referrals as needed to ensure patient’s needs are met and authorization is obtained.
•Reports denials and/or delays in the authorization process to the health care team and/or the patient. Provides information to the patient on the appropriate appeal process for denials as needed.
•Obtain retro prior authorization when requested.
•Adheres to department and organization policies addressing confidentiality, infection control, patient rights, medical ethics, disaster protocols, and safety.
•Demonstrates the ability to be flexible, open minded and adaptable to change
•Maintain competency in organizational and departmental policies/processes relevant to job performance.
•Performs other duties as assigned or needed to meet the needs of the department/organization.
•Provides a high level of customer service to internal and external customers.
•Uses L.E.A.D in dealing with dissatisfied patients.