Central Authorization Specialist /Full Time/ Remote-Michigan Residents

Henry Ford Hospital • Troy, MI

75d • Remote

About The Position

The purpose of the Central Authorization Specialist position is to centrally facilitate the successful procuring of insurance authorizations for ordered procedures and post-operative care. This will be done through quality validations of obtained authorizations as well as continuous education and opportunity feedback to a multi-disciplinary team with the underlying objective of managing the cost of care and providing timely and accurate information to payors. The Central Authorization Specialist helps drive change by identifying areas where performance improvement is needed (e.g., day to day workflow, education, process improvements, patient satisfaction). The Central Authorization Specialist is accountable for a designated caseload and plans effectively in order to meet demands and support resources procuring authorizations. Under general supervision and in accordance with established policies and procedures the specific functions within this role include: Subject matter expertise of precertification and payor authorization processes. Ensure successful authorizations are procured by ordering physician offices through validation of work effort and education of procuring staff. Ensure feedback relevant to successful authorization procurement is obtained from back end coding, billing and denial management resources and distributed to ordering physicians and authorization procurement staff to promote continuous improvement. Application of process improvement methodologies. The responsibilities includes acting as a centralized resource for assigned specialty across all sites of practice to ensure standardized and consistent procurement of authorizations.

Requirements

• High School diploma or equivalent combination of education and experience.
• 3-5 years of experience in a medical clinic setting or training in a hospital or corporate setting.
• 2 years of experience related to healthcare insurance verification and/or billing.
• 2-3 years of progressively responsible related work experience.
• Knowledge of coding and clinical terminology.
• Understanding of patient treatment plans for obtaining authorizations.
• Ability to interpret RN or Physician notes.
• Ability to evaluate and communicate additional requirements to RN/Physician staff.
• Strong organizational and time management skills.
• Ability to work independently and exercise sound judgment.
• Strong oral and written communication skills.
• Strong analytical and data management skills.
• Ability to work with all levels of management.
• Strong interpersonal communication and negotiation skills.

Nice To Haves

• Additional coursework in business, computers, or health care administration.
• Experience in a medical or surgical specialty clinic.
• Current working knowledge of hospital operations, utilization management, case management, and managed care reimbursement.
• General understanding of revenue cycle with emphasis on billing, coding, charge capture, and reimbursement.

Responsibilities

• Facilitate the successful procuring of insurance authorizations for ordered procedures and post-operative care.
• Perform quality validations of obtained authorizations.
• Provide continuous education and feedback to a multi-disciplinary team.
• Identify areas for performance improvement in workflow, education, and patient satisfaction.
• Accountable for a designated caseload and plan effectively to meet demands.
• Act as a subject matter expert in precertification and payor authorization processes.
• Ensure successful authorizations are procured by validating work efforts and educating staff.
• Obtain and distribute feedback from coding, billing, and denial management resources.
• Apply process improvement methodologies.
• Act as a centralized resource for assigned specialty across all sites of practice.

What This Job Offers

• Industry: Hospitals
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees