Authorization Specialist - Cardiology

Summit Health•Glastonbury, CT

About The Position

We’re a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care. Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through VillageMD and our operating companies Village Medical, Village Medical at Home, Summit Health, CityMD, and Starling Physicians. When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care. Please Note: We will only contact candidates regarding your applications from one of the following domains: @summithealth.com, @citymd.net, @villagemd.com, @villagemedical.com, @westmedgroup.com, @starlingphysicians.com, or @bmctotalcare.com. Job Description The Authorization Specialist is responsible for obtaining authorizations for surgical procedures, diagnostic testing, medications, DME, outgoing referrals, and other services as part of the daily operations. Authorization Specialists must have a keen understanding of medical insurance and the clinical policies that determine the authorization protocols for each health plan.

Requirements

High School Graduate/GED Required.
Experience Standard Office Technology in a Window based environment & Microsoft Office Suite Required.

Nice To Haves

Vocational / Technical School / Diploma Program Preferred
2-4 of related experience Preferred
Experience with Standard Office Equipment (Phone, Fax, Copy Machine, Scanner, Email/Voice Mail) Preferred.

Responsibilities

Identifies all appointments and procedures for assigned departments that require authorization by monitoring the schedules, system reports, and dashboards
Identifies the referral and authorization requirements of the patients’ insurance plans by using various on-line resources according to department workflows
Demonstrates knowledge of insurance carrier guidelines , clinical policies, and state guidelines pertaining to referrals and prior authorization
Verifies insurance eligibility and benefits, and updates the patient’s insurance information as necessary
Completes referrals and prior authorizations in a timely manner according to department guidelines and workflows
Communicates clearly and effectively with patients, physicians, office staff and manager to resolve issues that may result in a denied or delayed authorization request.
Demonstrates complete system knowledge, ability to run reports, document and manage referrals and authorizations, move correspondence, resolve eligibility and authorization holds, and other system tasks within the user’s security access
Demonstrates the ability to request, prepare, and recognize the documentation required to support the medical necessity for the service being authorized
Provides the supervisor and manager with immediate feedback on issues affecting workflow, reimbursement, and customer service.
Ensures that appropriate and accurate information is entered in the patient account
Responds timely and collaborates effectively with the Reimbursement Department teams to limit denials and ensure proper reimbursement
Collaborates with team members to meet department deadlines and benchmarks
Demonstrates the ability to use the electronic tools and systems available to organize and process the daily work
Anticipates and performs necessary job duties.
Maintains patient confidentiality
Expert in selecting the correct insurance package in Athena Collector.
Updates authorizations and claims to reflect the new insurance package.
Expert in sorting work queues and reports to identify and process the daily work (Manage Schedules - Inbound Referral Report - Outgoing Referrals)
Moves correspondence from the dashboard to the patient’s account.
Expert in generally accepted insurance benefit terms and processes.
Expert in Communication (Case and authorization notation - Physician and Practice location staff – Peers - Supervisor/Manager – Payers)
Expert in requesting and preparation of supporting documentation such as medical records, dictation, and orders.
Expert in investigation of authorization denials and appeals (Insurance – Patient)