CENTRAL AUTHORIZATION SPECIALIST

<p>The purpose of the Central Authorization Specialist position is to centrally facilitate the successful procuring of insurance authorizations for ordered procedures and post-operative care. This will be done through quality validations of obtained authorizations as well as continuous education and opportunity feedback to a multi-disciplinary team with the underlying objective of managing the cost of care and providing timely and accurate information to payors'. The Central Authorization Specialist helps drive change by identifying areas where performance improvement is needed (e.g., day to day workflow, education, process improvements, patient satisfaction). The Central Authorization Specialist is accountable for a designated caseload and plans effectively in order to meet demands and support resources procuring authorizations. Under general supervision and in accordance with established policies and procedures the specific functions within this role include: Subject matter expertise of precertification and payor authorization processes. Ensure successful authorizations are procured by ordering physician offices through validation of work effort and education of procuring staff. Ensure feedback relevant to successful authorization procurement is obtained from back end coding, billing and denial management resources and distributed to ordering physicians and authorization procurement staff to promote continuous improvement. Application of process improvement methodologies. The responsibilities includes acting as a centralized resource for assigned specialty across all sites of practice to ensure standardized and consistent procurement of authorizations.</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>