Authorization Specialist

SIHO HOLDING INC•Columbus, IN

1d•Onsite

About The Position

The Authorization Specialist is a non-exempt position reporting to the Manager, Utilization Management. The role provides administrative support to the Medical Management Team, including responding to telephone inquiries from physician offices and entering demographic and structured clinical data into the electronic authorization system. It does not involve clinical decision-making. The specialist helps coordinate and streamline authorizations by screening requests for precertification requirements, eligibility, and completeness before transferring them to Utilization Review. The role also supports provider and member needs, obtains clinical notes, assists Utilization Managers with daily functions and care planning, and provides education to provider offices about Medical Management processes.

Requirements

High school diploma or GED.
Excellent telephone skills.
General knowledge of Microsoft Office software.
Knowledge of medical terminology or willingness to learn.
Good organizational and prioritization skills, primarily self-directed.
Ability to communicate effectively with all SIHO customers.
Ability to work cohesively as a member of the Medical Management team.
Willingness to be flexible and meet departmental and corporate needs as they change.
Ability to consistently meet performance requirements.
Professional appearance and presence.
Ability to maintain excellent interpersonal communication in an office environment.
Confirmation of an excellent attendance record.
General knowledge and understanding of an office environment.

Nice To Haves

Some college.

Responsibilities

Comply with local, state, and federal accreditation standards for collecting and entering structured clinical data.
Comply with HIPAA guidelines and regulations and with Medical Management and SIHO policies and procedures.
Screen authorization requests for precertification requirements, eligibility, and completeness before transferring them to Utilization Review.
Triage incoming calls to the Medical Management Department and contact providers regarding Utilization Review decisions.
Coordinate with other SIHO departments to address member and provider needs in a timely manner.
Enter authorization demographic and structured clinical data into the SIHO authorization system and transfer requests to the appropriate clinical reviewer.
Complete authorization entry for non-SIHO delegated requests for claims adjudication.
Assist provider offices with education regarding Medical Management processes.
Perform Medical Management functions that do not require evaluation or interpretation of clinical data.
Obtain clinical notes and contact providers as needed to support Utilization Managers’ daily functions and care planning.