Pre Service IV Auth Specialist

MultiCare Health System

2d•$22 - $31•Onsite

About The Position

The Pre-Service IV/Auth Specialist is responsible for completing pre-authorization by patient type and anticipated healthcare service, which includes verifying insurance information (eligibility and benefits), validating referrals and prior authorizations, and submitting and monitoring pre-authorizations while meeting daily productivity and quality standards for the MultiCare Health System. This role acts as a resource regarding front end workflows, authorizations, and insurance plan guidelines; secures financial resources and ensures financial clearance for healthcare services provided to patients; communicates Advance Beneficiary Notice (ABN) issues to referring providers; works with referring providers to resolve pre-service authorization denials; and serves as a functional expert for peers across Patient Access and clinical areas as it relates to financial clearance. This position requires the ability to interpret medical guidelines, benefits, policies, and procedures to ensure financial clearance and the efficient operation of patient healthcare services.

Requirements

Minimum two (2) years of experience in pre-authorization, referral coordination, or in insurance billing, admitting, or registration within a healthcare setting
Customer service experience in healthcare
Proficiency in medical terminology, validated by examination
Experience reviewing medical policies and interpreting CPT and HCPCS codes in alignment with payer guidelines

Nice To Haves

Completion of a health vocational program (e.g., Medical Assistant, Medical Billing & Insurance) preferred
One (1) year of post-secondary business or college coursework preferred
Certification from the National Association of Healthcare Access Management (NAHAM) preferred

Responsibilities

Secure pre-authorizations from insurance companies for a broad range of services, including office visits, in-office procedures and injections, diagnostic and advanced imaging studies, and therapy sessions.
Respond to clinical inquiries through insurance portals to support timely authorization approvals.
Review medical records and supporting documentation to ensure complete and accurate submission for ordered services.
Evaluate and process medical authorization requests efficiently to facilitate uninterrupted patient care.
Communicate effectively with healthcare providers, insurance carriers, and patients to gather and relay information necessary for authorization decisions.
Meet established daily productivity standards to maintain operational efficiency and accuracy in authorization workflows.
Perform essential registration tasks such as loading insurance details, filing orders, and verifying eligibility.
Maintain a high level of accuracy to reduce the risk of insurance claim denials and ensure financial clearance for patients.
Serve as a subject matter expert on referrals, authorizations, and insurance plan guidelines within the MultiCare Health System.