Authorization Specialist II

Albany Medical Center•Glens Falls, NY

1d•$50,639 - $75,959•Onsite

About The Position

The Authorization Specialist II (AS II) is responsible for financially securing Ambulatory, Ancillary, Surgical and Procedural services. This includes securing Referral and Authorization. Insurance Verification and Benefit interpretation to discern insurance guidelines are being adhered to. Ability to interact with patients and stakeholders for the successful financial clearance will be critical to be successful in the compliance of authorization and referral guidelines. Position requires ability to work in a high-volume, fast-paced environment. Understanding complex scheduling needs of our patients in an empathetic, compassionate manner is critical. Position is required to use eligibility application and authorization portals to invoke request to verify insurance eligibility, interpret response and capture appropriate health insurance information as it pertains to the service being rendered. The position requires ability to understand and apply contractual benefits to the service being rendered, with ability to collect patient financial obligation pre-services. Additionally, the AS II has responsibility to onboard new team members, post their successful completion of The Academy.

Requirements

Associate's Degree - required
Strong insurance knowledge specific to complex scheduling needs and authorization management
Ability to precept new team members
Proven customer service skill with ability to exceed expectations
Demonstrated knowledge payer authorization requirements
Strong attention to detail
Ability to multi-task in stressful and high patient volume unit
Must be able to manage pressure of very tight timeframes to execute task
Ability to learn in classroom, utilizing resources
Ability to remain composure under pressure
Ability to train and onboard colleague
Ability to review information and draw appropriate conclusion
Good judgement and ability to be resourceful to problem solve; escalate issues as needed
Team minded worth ethic
Demonstrated ability interpret patient’s insurance benefits and apply the applicable contractual obligations
Critical thinking ability regarding issues with financially securing payment
CHAA (or acquired within 2 years of hire) - required
Learning Partner Module
Equivalent combination of relevant education and experience may be substituted as appropriate.

Nice To Haves

Bachelor's Degree - preferred
3 – 5 years’ experience in Hospital or Physician office experience or call center environment, - preferred

Responsibilities

Responsible for financial clearance of scheduled services for Hospital Surgical (Inpatient and Outpatient) and Clinic appointments, assuring no delay in payment of claim.
Precept new team members for successful onboarding to the Authorization Specialist I position.
Ability to identify authorization needs including but not limited to Out of Network management of appointments and encounters.
Responsible to interpret information received from Insurance Payer regarding patient’s eligibility and financial responsibility
Responsible to discuss financial obligation to patient, if required.
Ability to accurately interpret referral/physician order to meet the patient and/or provider need for scheduling of services correctly including multi-scheduling needs for related services
Responsible for scanning or managing online form template to maintain the Electronic Health Record
Comprehend Federal, State, Third Party Payer regulations as it pertains to a hospital and practice pre-registration.
Excellent knowledge of third- party payer authorization portals; authorization guidelines by payer and critical detail to follow up.
Responsible for review of services being rendered to ensure the appropriate setting of care has been assigned by the physician’s office
Obtains all insurance information from patient and verifies insurance to ensure active coverage for services being scheduling and obtains authorization via portal, fax and telephone.
Provides thorough comments, where applicable for all conversations with patients or providers.
Ability to organize work with multiple steps to ensure no scheduling or authorization needs are missed.