CENTRAL AUTHORIZATION SPECIALIST

<p>The Central Authorization Specialist serves as a centralized resource to facilitate the successful procurement of insurance authorizations for ordered procedures and post-operative care. Key responsibilities include:</p><ul><li>Validate obtained authorizations and ensure quality standards are met across all sites of practice</li><li>Provide subject matter expertise in precertification and payor authorization processes to ordering physician offices and procurement staff</li><li>Collect feedback from back-end coding, billing, and denial management resources and distribute findings to ordering physicians and authorization procurement staff to promote continuous improvement</li><li>Manage an assigned caseload while planning effectively to meet demands and support authorization procurement efforts</li><li>Identify performance improvement opportunities in workflow, education, and processes to drive organizational change and manage cost of care</li><li>Apply process improvement methodologies to standardize and enhance authorization procurement procedures</li></ul><p>All functions are performed under general supervision and in accordance with established organizational policies and procedures.</p> <p>**QUALIFICATIONS**</p><p>**Required:**</p><ul><li>High school diploma or equivalent; minimum 3-5 years of related experience in a medical clinic, hospital, or corporate healthcare setting</li><li>Minimum 2 years of experience in healthcare insurance verification and/or billing</li><li>Proficiency with computer systems and healthcare software applications</li><li>Knowledge of medical coding, clinical terminology, and patient treatment plans</li><li>Ability to interpret clinical notes and insurance documentation</li><li>Strong organizational and time management skills with ability to prioritize multiple tasks</li><li>Excellent written and oral communication skills</li><li>Ability to work independently and exercise sound judgment with physicians, payors, and patients</li></ul><p>**Preferred:**</p><ul><li>Experience in a medical or surgical specialty clinic</li><li>Knowledge of hospital operations, utilization management, and managed care reimbursement</li><li>Understanding of revenue cycle processes including billing, coding, and reimbursement</li><li>Additional coursework in business, healthcare administration, or related field</li><li>Experience with process improvement methodologies</li></ul>