The Hospital Authorization Specialist reviews databases and other pertinent documentation to ensure all needed pre-certifications and/or authorizations are completed for medical services. Works with all clinics and appropriate ancillary departments to ensure requirements are met through training, education and consultation. Must be familiar with and remain current of insurance carriers and requirements to include a working knowledge of referral and pre-certification processes and medical necessity guidelines. Must demonstrate exceptional customer service to patients, referring sources both internal and external. This position requires the ability to effectively communication information to the patient related to testing, required preparations and financial obligations.
EDUCATION, EXPERIENCE, TRAINING
1. Knowledge of standard insurance companies and verification requirements.
2. Well versed in authorization processes for all payers
3. Knowledge of medical terminology
4. Basic computer skills
5. Knowledge of Common Procedural Terminology (CPT), ICD codes
6. Ability to multi-task, prioritize needs to meet required timelines
7. Analytical and problem-solving skills
8. Customer Services experience required
9. High School Graduate or GED Equivalent required (effective 4/1/14 for all new hires)
10. 3-5 years pre-certification processes and medical necessity guidelines preferred
We are an Equal Opportunity/Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law: https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf