Licensed Practical Nurse or Medical Assistant - AUTHORIZATION SPECIALIST- Various Practices - Full Time

Meadville Medical Center•Meadville, PA

About The Position

An Authorization Specialist is a healthcare professional with office experience who manages the prior authorization process. This includes helping to gather and process information between the medical provider, insurance company and billing department to ensure Meadville Medical Center will be paid for services provided to our patients. The Authorization Specialist ensures patients have been granted authorization for scheduled medical services. This position requires a highly focused and dependable staff member that will process testing orders, insurance authorizations, and urgent and routine and referrals. Strong working knowledge of medical terminology and procedures is desired. Prepare and submit precertification and prior authorization requests in accordance with insurance requirements for scheduled tests, procedures, medications, and durable medical equipment (DME). Serve as a liaison between the hospitals, physician offices, insurance providers, patients, and referral sources to ensure seamless coordination of care. Obtain and review clinical documentation, including physician records, to support medical necessity for authorizations. Demonstrate strong knowledge of provider charting practices and efficiently navigate electronic medical records (EMR) to locate supporting documentation. Maintain detailed and accurate documentation of all communications with patients, families, healthcare providers, and insurance companies. Process and track referrals and authorization requests, ensuring timely completion and follow-up. Stay current with changes in health insurance policies and communicate updates related to authorization requirements to appropriate staff. Communicate effectively and professionally, both verbally and in writing, with all stakeholders. Follow up promptly with providers and office staff regarding authorization statuses and additional requirements. Ensure strict adherence to HIPAA compliance and patient confidentiality standards. Manage incoming calls, respond to inquiries, and process faxed documentation efficiently. Update patient records with referral details, appointment information, and other relevant data. Collaborate with providers and nursing staff regarding referral processes and changes in requirements. Monitor workload to ensure all referrals and authorizations are completed accurately and on time. Other duties as assigned.

Requirements

High school diploma or GED
MA or LPN
Two years’ experience in healthcare
EMR systems and Insurance companies.
Able to read and write consistent with job requirements, cognitive skills as related to the position.
Able to take and follow through with delegated tasks and accountability
Excellent typing, data entry skills, and communication skills oral and written
Knowledge of HIPAA regulations
Being helpful, respectful, approachable, and team oriented, building strong working relationships and a positive work environment.
Planning ahead, managing time well, being on time, being cost conscious, thinking of better ways to do things.
Striving for high patient satisfaction, going out of our way to be helpful and pleasant, making it as easy as possible on the patient.
Must be able to deal with anxious and angry people in a calm and professional manner.
Clear speaking voice, seeing with or without mechanical devices, hearing, sitting, walking, reaching, typing, computer usage, standing and lifting.
Use of computers, printers, fax machines, copiers, and telephone.

Responsibilities

Prepare and submit precertification and prior authorization requests in accordance with insurance requirements for scheduled tests, procedures, medications, and durable medical equipment (DME).
Serve as a liaison between the hospitals, physician offices, insurance providers, patients, and referral sources to ensure seamless coordination of care.
Obtain and review clinical documentation, including physician records, to support medical necessity for authorizations.
Demonstrate strong knowledge of provider charting practices and efficiently navigate electronic medical records (EMR) to locate supporting documentation.
Maintain detailed and accurate documentation of all communications with patients, families, healthcare providers, and insurance companies.
Process and track referrals and authorization requests, ensuring timely completion and follow-up.
Stay current with changes in health insurance policies and communicate updates related to authorization requirements to appropriate staff.
Communicate effectively and professionally, both verbally and in writing, with all stakeholders.
Follow up promptly with providers and office staff regarding authorization statuses and additional requirements.
Ensure strict adherence to HIPAA compliance and patient confidentiality standards.
Manage incoming calls, respond to inquiries, and process faxed documentation efficiently.
Update patient records with referral details, appointment information, and other relevant data.
Collaborate with providers and nursing staff regarding referral processes and changes in requirements.
Monitor workload to ensure all referrals and authorizations are completed accurately and on time.
Other duties as assigned.