CENTRAL AUTHORIZATION SPECIALIST

<p>The Central Authorization Specialist facilitates the successful procurement of insurance authorizations for ordered procedures and post-operative care. Key responsibilities include:</p><p>&#xa0;</p><ul><li>Validate obtained authorizations and provide continuous education and feedback to ordering physician offices and authorization procurement staff to ensure quality and timeliness</li><li>Manage a designated caseload and plan effectively to meet authorization procurement demands while supporting clinical and administrative resources</li><li>Serve as subject matter expert on precertification and payor authorization processes, applying process improvement methodologies to identify and address performance gaps</li><li>Obtain feedback from coding, billing, and denial management resources and distribute relevant findings to ordering physicians and procurement staff to promote continuous improvement</li><li>Act as a centralized resource across all practice sites to ensure standardized and consistent authorization procurement within assigned specialties</li><li>Drive organizational change by identifying workflow improvements, education needs, and opportunities to manage cost of care while providing timely and accurate information to payors</li></ul><p>&#xa0;</p> <p>**REQUIRED QUALIFICATIONS:**</p><ul><li>High school diploma or equivalent; OR 3-5 years of related experience in a medical clinic, hospital, or corporate setting</li><li>Minimum 3-5 years of experience in healthcare insurance verification and/or billing</li><li>2-3 years of progressively responsible related work experience in healthcare administration or revenue cycle operations</li><li>Advanced computer literacy and proficiency with healthcare information systems</li><li>Working knowledge of precertification and payor authorization processes</li><li>Knowledge of medical coding and clinical terminology</li><li>Ability to interpret clinical notes from RNs and physicians to facilitate authorization procurement</li><li>Ability to evaluate and communicate authorization requirements and roadblocks to clinical and administrative staff</li><li>Strong organizational and time management skills with demonstrated ability to prioritize multiple tasks</li><li>Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients</li><li>Strong oral and written communication skills</li><li>Strong analytical and data management capabilities</li><li>Ability to collaborate effectively with all levels of management and cross-functional teams</li><li>Strong interpersonal communication and negotiation skills</li></ul><p>**PREFERRED QUALIFICATIONS:**</p><ul><li>Additional coursework or certification in business, healthcare administration, or health information management</li><li>Experience in a medical or surgical specialty clinic setting</li><li>Ability to interpret insurance records and related documentation</li><li>Current working knowledge of hospital operations, utilization management, and case management</li><li>Understanding of managed care reimbursement models</li><li>General understanding of revenue cycle with emphasis on billing, coding, charge capture, and reimbursement</li><li>Experience interacting with clinicians and finance personnel in a healthcare setting</li></ul>