Authorization Specialist - ENI

EvergreenHealth•Kirkland, WA

1d•$24 - $38•Onsite

About The Position

Expedites the administrative requirements for patient care, including clinical authorizations based on specialty provider orders, dealing directly with health plans. Makes decisions and authorizes risk planning referrals, utilizing department and organizational guidelines. Requires daily interaction with patients, staff, healthcare providers, and insurance companies. All job functions are carried out within the EvergreenHealth Medical Group clinic(s) to which assigned.

Requirements

Associate degree or equivalent combination of education and experience
3 years of experience in a healthcare insurance or related medical office setting
General clinical knowledge related to medications, procedures, imaging, infusions, etc.
Working knowledge of ICD10 and CPT codes
Working knowledge of insurances, Medicare, DSHS, Labor and Industries, and other third-party insurances
Medical Terminology, medical billing, and computer skills
Ability to be flexible and relate well with others in a professional and pleasant manner
Knowledge of medical records confidentiality
Excellent communication skills with a high degree of tact and poise to deal effectively with patients, physicians, and hospital staff members

Nice To Haves

Recent specialty clinic authorization experience for medications, procedures, imaging, infusions, surgeries, etc.

Responsibilities

Accurately and successfully processes authorizations for medications, procedures, imaging, infusions, surgeries, etc. ordered by clinic providers by working directly with health plans.
Minimizes care delays by avoiding denials and peer-to-peer escalation between payers and providers.
Maintains written best practice guidelines for each service and each payer, expanding on the contracted payer list to include coverage requirements, documentation, and authorization submission requirements for successful approval.
Serves as main point of contact and escalation point for clinical and non-clinical colleagues regarding insurance authorizations.
Develops and provides clinic staff training on insurance plan requirements and coverage for authorization of medications, procedures, imaging, infusions, etc.
Educates and periodically reviews workflow related to non-covered services, price quotes, etc. with front office staff.
Maintains charge masters for department, including fee structure, and makes recommendations for changes to the management team.
Addresses and resolves patient complaints regarding charges by liaising with Professional Billing and Patient Financial Services on behalf of the patient, including following up with patients directly.
Attends and participates in all departmental meetings and activities.
Answers phone lines in support of care coordination when needed.
Backs up front and back-office colleagues with records requests, chart prep, scanning, scheduling, and other admin care coordination work when needed for patient flow and safety.
Performs other duties as assigned.