Authorization Specialist.

METRO COMMUNITY HEALTH CENTER•Pittsburgh, PA

About The Position

This position will facilitate the mission of Metro Community Health Center to ensure the delivery of quality patient care and coordination of supportive services within the health center. The individual will administer to the needs of the patients by following the scope of practice and standards of care accurately.

Requirements

High school diploma or equivalent
3-5 years of prior experience performing authorizations and referrals
Some combination of education/certification may be accepted in lieu of experience.
Demonstrated experience of developing an effective rapport with the patients, staff members, insurance companies, etc. in an effort to provide comprehensive healthcare across the life span.
Significant knowledge of medical practices and insurance within a primary care environment
Knowledge of relevant prior authorization portals
Knowledge of formularies and other insurance related procedures regarding prior authorizations
Communication Skills
Knowledge and understanding of EMR software.
Medical Terminology
CPT
ICD-10
Customer Service
Computers/Microsoft Office Suite (Excel, Word, Etc)
Medical Insurance Knowledge
Medicare/Medicaid
Private Payers

Nice To Haves

Athena One experience preferred.

Responsibilities

Demonstrate a high level of skill at building relationships and customer service
Demonstrate interpersonal savvy and influence skills in managing difficult clients and patients
Demonstrate high degree of knowledge and competency in the practice of medicine and associated charting requirements
Demonstrate a high level of problem-solving skills to better serve patients and staff
Strong attention to detail and accuracy
Ability to utilize computers for data entry and information retrieval
Excellent verbal and written communication skills.
Continually improve work process to enhance service and customer relations
Works to improve prior authorization processes, communication, and patient care as it relates to various insurance companies’ regulations.
Demonstrated success and familiarity with tools, technology, and systems typically found within most progressive health care environments (i.e. personal computer skills, spreadsheets, word processing, patient records systems, EMR systems, etc.)
Experience with insurer’s authorization submission portals preferred
Responsible for receiving, processing and documenting referral and prior authorization requests (medications, test/procedures, DMEs, etc.).
Stay abreast of continual changes in the health insurance Managed Care arena and communicates those changes as appropriate.
Assists the clerical and clinical teams with the coordination of patients
Have an understanding of provider charting practices and how to find supporting documentation inside the patient chart
Attend meetings, patient conferences, planning sessions, related to quality assurance, patient care, and other related topics within the health center
Attend seminars and maintain all certifications requirements for continuing education and best practices
Participate in quality strategies to evaluate compliance with standards and to identify opportunities to improve patient outcomes
Assists the clinical team with quality assurance standards and measures
Ability to utilize computers for data entry and information retrieval
Excellent verbal and written communication skills in a professional manner
Ability to implement, and evaluate operational and administrative processes
Maintains HIPAA compliance practices at all times
Ensures insurance carrier documentation requirements are met and referral support documentation is charted in patient's medical record.
Efficiently manages correspondence with patients, physicians, specialists, and insurance companies.
Work in coordination with medical providers regarding issues in documentation, diagnoses, etc in regard to patient’s prior authorizations.
Work in coordination with medical providers regarding denials to ensure quality patient outcomes.
Documents pertinent information in the patient record regarding authorizations and communications with patients.
Works in collaboration with the Financial Department to improve the Revenue Cycle
Performs other duties as assigned