The Authorization Specialist in the Pre Access Services department is primarily responsible for completing benefits review and prior authorization as required by all payers for scheduled services. The Specialist interfaces directly with physicians, practice staff, payer representatives and patients on a daily basis to review scheduled services and to ensure complete and accurate information is documented. This role completes necessary clinical review for prior authorizations as required by governmental and commercial payers; satisfying maximum net revenues and minimum avoidable losses for authorizations. The ability to multi-task in multiple business office / practice management systems and offer exceptional customer call service is the foundation of this role.
Required Education: High school diploma or equivalent.
Preferred Education: Associates Degree in medical office management, medical insurance, or medial coding.
Required License: None
Preferred License: Certified Coder
Required Experience: Three years of experience working in hospital service access, clinical service access, physician office scheduling, medical records, or medical coding. Or successful completion and demonstrated competency of the required Revenue Cycle Education Body of Knowledge for Pre Access Services.Proficient in Microsoft Word and Excel. Strong written and verbal communication skills. Must be able to work well with co-workers, physicians and nursing staff. Ability to work independently and with the many levels of customers. Must have experience with critical thinking and problem solving.
Preferred Experience: Five years of experience in a medical services front office, coding or coding assistance. Experience with Cerner Millennium, Allscripts Enterprise Practice Management System, Healthquest, Artiva, Insurance claims and Medicaid eligibility.Qualified Spanish-speaking applicants encouraged to apply.