CENTRAL AUTHORIZATION SPECIALIST

<p>**RESPONSIBILITIES:**</p><p>The Central Authorization Specialist facilitates the successful procurement of insurance authorizations for ordered procedures and post-operative care across assigned specialties and all practice sites. Key responsibilities include:</p><ul><li>Serve as subject matter expert in precertification and payor authorization processes, ensuring successful authorizations through validation of work effort and staff education</li><li>Provide centralized quality validation of obtained authorizations and distribute feedback from coding, billing, and denial management resources to ordering physicians and authorization procurement staff to promote continuous improvement</li><li>Drive performance improvement by identifying workflow inefficiencies, education gaps, and process enhancement opportunities to manage cost of care and ensure timely, accurate information to payors</li><li>Manage designated caseload independently, planning effectively to meet authorization procurement demands while supporting multi-disciplinary teams across all sites of practice</li><li>Maintain standardized and consistent authorization procurement processes across specialty areas and locations</li></ul> <p>**REQUIRED QUALIFICATIONS:**</p><ul><li>High school diploma or equivalent; OR 3-5 years of related experience in a medical/healthcare setting</li><li>Minimum 3-5 years of experience in a medical clinic, hospital, or corporate healthcare setting</li><li>2+ years of experience in healthcare insurance verification and/or billing</li><li>Advanced computer literacy and proficiency with healthcare systems</li><li>Knowledge of medical coding and clinical terminology</li><li>Ability to interpret clinical notes from RNs and physicians</li><li>Ability to interpret insurance records and related documentation</li><li>Strong organizational and time management skills with ability to prioritize multiple tasks</li><li>Excellent oral and written communication skills</li><li>Strong analytical and data management capabilities</li><li>Ability to work independently and exercise sound professional judgment</li><li>Ability to interact effectively with physicians, payors, patients, and families</li><li>Strong interpersonal and negotiation skills</li><li>Ability to collaborate with all levels of management and clinical/finance personnel</li></ul><p>**PREFERRED QUALIFICATIONS:**</p><ul><li>2-3 years of progressively responsible experience in healthcare administration or authorization management</li><li>Experience in a medical or surgical specialty clinic</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, including billing, coding, charge capture, and reimbursement</li><li>Additional coursework in business, computers, or healthcare administration</li><li>Experience with process improvement methodologies</li></ul>