Authorization Specialist

Riverview Health•Noblesville, IN

23h

About The Position

The Authorization Specialist ensures that payers are prepared to reimburse Riverview Health for scheduled services in accordance with payer-provider contracts. The Specialist contacts payers to request service authorization and may gather clinical, financial, or demographic information from clinics, hospital departments, or patients as needed.

Requirements

Associate degree in healthcare or business administration and/or related coursework, or comparable experience.
At least two years of experience in a healthcare setting performing related tasks.

Nice To Haves

Experience with Epic.
Five years of experience in a healthcare setting performing related tasks.

Responsibilities

Verifies patients’ insurance and benefits information.
Obtains prior authorizations from third-party payers in accordance with payer requirements.
Identifies patients who need Medicare Advance Beneficiary Notices of Noncoverage (ABNs).
Contacts patients to gather demographic and insurance information as needed and updates patient information in the EMR.
Works with other departments to gather clinical information required by payers to authorize services.
Maintains accurate authorization records in the EMR.
Develops price estimates for patients’ out-of-pocket responsibility.
Refers accounts to financial counseling when authorization is not obtained.
Works with business office staff to support appeals for authorization-related denials.
Reviews surgery schedules to ensure Medicare patients with inpatient-only procedures have the appropriate authorization and order.
Complies with HIPAA regulations and Riverview Health policies and procedures regarding patient privacy and confidentiality.
Maintains a professional tone when communicating with patients and payer representatives.
Coordinates re-education for practices or hospital departments when orders are incorrect or not supported by the diagnosis.
Performs other duties as requested.