Authorization Specialist

Lehigh Valley Health Network • Pottstown, PA

2d • Onsite

About The Position

Obtains benefits and authorizations for surgical procedures, diagnostic testing, medications, outgoing referrals, and other services as part of daily operations. Determines authorization protocols for each health plan and performs billing duties to help ensure proper and timely payment from insurance carriers and patients. The position is onsite at the Pottstown, 1601 Medical Drive location, with a Monday–Friday, 8 a.m.–5 p.m. schedule and a day shift.

Requirements

• High school diploma or GED with specialized training in insurance, coding, billing, or a similar healthcare certificate program.
• At least 1 year of experience in a healthcare setting with insurance verification or authorizations.
• Familiarity with billing procedures and payer reimbursement.
• Knowledge of patient rights and laws related to those rights, such as HIPAA.
• Proficiency in utilization management processes, standards, and managed care.
• Proficiency in standard medical practices and insurance benefit structures.

Nice To Haves

• Associate’s degree.

Responsibilities

• Collaborate with physicians and provider office staff to determine appropriate authorization based on medical necessity and the treatment plan.
• Perform medical necessity checks to determine whether procedures and diagnoses support medical necessity.
• Obtain authorizations in accordance with network policy and communicate authorization issues outside policy guidelines to the ordering office, patient, and manager.
• Communicate with insurance companies to obtain insurance verification, benefits, and precertification approvals.
• Verify additional clinical information and insurance authorizations or referrals.
• Review and monitor work queues and schedules to ensure accurate authorization is received before a patient’s visit.
• Maintain compliance with benchmark data regarding accounts registered versus scheduled procedures.
• Determine estimated patient financial responsibility using insurance verification information and payer contracts or self-pay guidelines.
• Perform billing duties to help ensure proper and timely payment from insurance carriers and patients.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED