Authorization Generalist

Essential Duties and Responsibilities

• Ensures proper insurance information is obtained.
• Works with the clinical team on ensuring insurance payers have appropriate clinical documentation needed to process prior authorizations in a timely manner.
• Relays patient information to insurance companies for certification and authorization of procedures, medications, treatments, imaging, and rehabilitation services.
• Ensures proper documentation of authorization processes, approvals, denials, effective dates, and end dates in the electronic medical record.
• Conduct thorough research to ensure accurate responses to complex patient inquiries.
• Prioritizes the incoming authorizations by level of urgency.
• Reviews orders for medical necessity purposes.
• Works willingly and accepts assignments as given.
• Attends all mandatory meetings and programs.
• Participates in opportunities that enhance personal and professional growth.
• Performs other duties as necessary or assigned.
• Complies with the Corporate Compliance Policy and all laws, regulations, and Standards of Conduct relating to the position and agrees to report any suspected violations of law or Standards of Conduct.
• Complies with all applicable state and federal regulations and JCAHO standard.
• Maintains a safe work environment using safe work practices, utilizing standard precautions and complying with hazardous waste procedures at all times as described in St. Anthony's Safety Manual.
• Maintains the confidentiality of patient, resident, employee and organizational information.

Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

• High school diploma or equivalent.
• Previous work experience in a healthcare related field required.
• Previous medical insurance experience.

Position Requirements, Licenses, Certifications, Registrations

• Excellent verbal and written communication skills.
• Detailed oriented with excellent organizational skills.
• Ability to effectively and efficiently manage a high-volume and time-sensitive workload.
• Knowledge of CPT and ICD-10 codes.
• Proficient in computer systems and Microsoft Office products.

Language Skills
Ability to read and interpret documents such as financial reports, insurance documents, safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before customers, patients, families and employees of the organization. Ability to read, analyze, and interpret healthcare regulations.

Language Skills
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from managers, customers, patients, families and the general public.

Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit; talk and hear; reach with hands and arms; and use hands to finger, handle or feel. The employee is occasionally required to stand, walk, and climb or balance. The employee must be able to lift and/or move up to 15 pounds at times, and occasionally lift and/or move up to 35 pounds. Specific vision abilities required by this job include close vision, distance vision, depth perception, and ability to adjust focus. Computer work is frequent.

Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Due to the nature of business in a health care setting, although risk is minimal, any employee of St. Anthony may be exposed to moving mechanical parts, fumes or airborne particles, blood borne pathogens, unpleasant sights, odors, and/or materials in patient care and/or provider work areas.

The noise level in the work environment is usually quiet.

Experience

• • High school diploma or equivalent. • Previous work experience in a healthcare related field required. • Previous medical insurance experience.

Education

• High School or better