Authorization Specialist

Great Plains Health•North Platte, NE

About The Position

The Authorization Specialist provides comprehensive care coordination for assigned patients. The role assesses each patient’s plan of care and develops, implements, monitors, and documents utilization of resources and patient progress, facilitating options and services that meet healthcare needs. The intensity of care coordination is situational and appropriate to patient needs and payer requirements. The position works closely with physicians, nurses, schedulers, and the patient financial services team.

Requirements

High school diploma or equivalent.
Knowledge of medical terminology, CPT codes, and IDC codes.

Nice To Haves

A degree in Secretarial Administration, Health Care Administration, Business, and/or Accounting is preferred.

Responsibilities

Manage individual patients across the healthcare continuum to achieve optimal clinical, financial, operational, and satisfaction outcomes.
Act in a leadership function in process-improvement activities for patient populations to achieve optimal clinical, financial, operational, and satisfaction outcomes.
Effectively communicate the plan across the continuum of care.
Evaluate medical necessity and appropriateness of care to optimize patient outcomes.
Establish and promote collaborative relationships with physicians, payers, and other healthcare team members.
Collect and communicate pertinent, timely information to payers and others to fulfill utilization and regulatory requirements.
Work on denials to overturn them.
Educate internal healthcare team members on pre-authorizations and managed care concepts.
Serve as an informational and educational resource to outside facilities, including nursing homes, assisted living facilities, and rehabilitation centers.
Facilitate integration of utilization and managed-care concepts into daily practice.
Identify, collect, and communicate pertinent, timely information to fulfill utilization and regulatory requirements.