Authorization Specialist

Lehigh Valley Health Network•REMOTE IN PENNSYLVANIA, PA

2d•Remote

About The Position

Lehigh Valley Health Network (LVHN) is seeking an Authorization Specialist to obtain benefits and authorizations for surgical procedures, diagnostic testing, medications, outgoing referrals, and other services as part of daily operations. This role involves determining the authorization protocols for each health plan and performing billing duties to ensure proper and timely payment is received from insurance carriers and patients. LVHN is a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work, and has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. It is a Magnet(tm) Hospital, honored five times by the American Nurses Credentialing Center for nursing excellence and quality patient outcomes. Several LVHN facilities have also received 'A' grades from The Leapfrog Group for patient safety. LVHN is committed to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.

Requirements

High School Diploma/GED with specialized training in insurance, coding, billing, or similar healthcare certificate programs.
1 year in a healthcare setting with insurance verification/authorizations.
Familiarity with billing procedures and payer reimbursement.
Knowledge of patient rights and laws relative to those rights, such as HIPAA.
Proficient in utilization management processes, standards, and managed care.
Proficient in standard medical practices and insurance benefit structures.

Nice To Haves

Associate’s Degree

Responsibilities

Obtains benefits and authorizations for surgical procedures, diagnostic testing, medications, outgoing referrals, and other services as part of daily operations.
Determines the authorization protocols for each health plan and performs billing duties to ensure proper and timely payment is received from insurance carriers and patients.
Collaborates with physicians and provider office staff in ascertaining the appropriate authorization based on medical necessity and the treatment plan provided.
Performs a medical necessity check to determine if procedure and diagnosis support medical necessity.
Ensures authorizations are obtained in accordance to network policy (any authorization not falling into policy guidelines is communicated to ordering office, patient, and manager).
Communicates direct/indirect with insurance companies to obtain insurance verification, benefits and precertification for approval.
Verifies additional clinical information and insurance authorizations/referrals.
Reviews and monitors WQs/schedules to ensure that proper and accurate authorization has been received prior to patient’s visit.
Maintains compliance with benchmark data regarding accounts registered versus scheduled procedures.
Determines estimated patient financial responsibility using insurance verification information and payer contracts and/or self-pay guidelines.