PNW PACE Authorization Specialist

MultiCare Health System•Tacoma, WA

2d•Onsite

About The Position

The Authorization/Insurance Verification Specialist is responsible for managing authorizations, insurance and referrals for Multicare Ambulatory providers. Responsibilities include verification of insurance information (eligibility and benefits), referral management, submitting and monitoring of pre-authorizations, determines medical necessity and identifies any coverage concerns and works with providers and billing to resolve authorization denials. Other responsibilities include completing pre-registration as required by patient type and anticipated service. Incumbents work with staff and management throughout the revenue cycle, clinical teams, providers as well as representatives from insurance carriers and government agencies.

Requirements

One (1) year of post high school business or college course work preferred
Two (2) years of pre-authorization or referral coordinator experience OR Two (2) years of experience processing incoming claims or pre-authorization requests for an insurance payor OR Two (2) years insurance billing, admitting, or registration experience in a hospital or medical office OR Graduate of a health vocational program such as Medical Assistant, or Medical Billing & Insurance, and 1-year experience in healthcare
Minimum two (2) years of experience in dealing with the public in a customer service role
Medical Terminology proficiency by examination

Nice To Haves

National Association of Healthcare Access Management Certification (NAHAM) preferred

Responsibilities

Managing authorizations, insurance and referrals for Multicare Ambulatory providers.
Verification of insurance information (eligibility and benefits).
Referral management.
Submitting and monitoring of pre-authorizations.
Determining medical necessity.
Identifying any coverage concerns.
Working with providers and billing to resolve authorization denials.
Completing pre-registration as required by patient type and anticipated service.