System Authorization Specialist

St. Francis Medical Center•Cape Girardeau, MO

14d

About The Position

The Authorization Specialist reviews requests for prior authorization of medical services, including elective and outpatient surgeries and procedures, home health, out-of-network requests, and expedited medical-necessity requests. Reviews are conducted in accordance with government, commercial, and workers’ compensation health-plan coverage guidelines. The role determines benefits and documents information completely and accurately in accordance with healthcare system guidelines. The specialist works independently to solve problems and liaises with people outside the department to support smooth workflows and transitions of information needed for authorizations. The role promotes effective intra- and interdepartmental relationships, provides quality customer service, follows the department’s and Saint Francis Healthcare System’s mission, vision, values, and philosophy, and handles restricted or confidential information. Other duties may be assigned by the Manager and Director.

Requirements

High school graduate or equivalent required.

Nice To Haves

One year of experience in a healthcare setting obtaining insurance authorizations is strongly preferred.
Experience with CPT and ICD codes is a plus.

Responsibilities

Review prior authorization requests for medical services, including surgeries and procedures, home health, out-of-network requests, and expedited medical-necessity requests.
Apply government, commercial, and workers’ compensation health-plan coverage guidelines when reviewing requests.
Determine benefits and document information completely and accurately according to healthcare system guidelines.
Work independently to solve problems.
Liaise with people outside the department to support workflows and transitions of information needed for authorizations.
Promote harmonious and efficient intra- and interdepartmental relationships and provide quality customer service.
Adhere to the mission, vision, values, and philosophy of the department and Saint Francis Healthcare System.
Maintain restricted or confidential information.
Perform other duties as assigned by the Manager and Director.

Benefits

Medical, prescription, dental, and vision coverage, available on the first of the month after hire.
Saint Francis Medical Services Discount.
Earned Time Off based on relevant years of work history, combining vacation, sick time, holidays, and personal days.
Retirement benefits, including immediate SFHS matching.
Education assistance of up to $5,000 per calendar year for colleagues with one year of service, after graduation.
Benefit Support through Health Advocate.
Employee Assistance Program.
Flexible Spending Accounts.
Identity Theft Protection.
Pet Insurance.
Earned Wage Access.