System Authorization Specialist

Saint Francis Healthcare System•Cape Girardeau, MO

13d

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 completed in accordance with government, commercial, and workers’ compensation health plan coverage guidelines. The specialist determines benefits and documents information accurately and completely in accordance with healthcare system guidelines. The role requires working independently to solve problems and serving as a liaison with people outside the department to support smooth workflows and information transitions needed for authorizations. The specialist promotes effective intra- and interdepartmental relationships, provides quality customer service, adheres to the mission, vision, values, and philosophy of Saint Francis Healthcare System, and protects restricted or confidential information. Other duties may be assigned by the Manager and Director. The standard schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m. Saint Francis Healthcare System describes its work as part of a Catholic healing ministry focused on compassion, dignity, service, wellness, quality, and love.

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 elective and outpatient surgeries and procedures, home health, out-of-network services, 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 smooth workflows and transitions of authorization information.
Promote harmonious and efficient intra- and interdepartmental relationships.
Deliver quality customer service.
Adhere to the mission, vision, values, and philosophy of the departments and Saint Francis Healthcare System.
Maintain the confidentiality of restricted information from sources within the healthcare system.
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 date.
Saint Francis Medical Services Discount.
Earned Time Off based on relevant years of work history; it combines vacation, sick, holiday, and personal days.
Retirement benefits with immediate SFHS matching.
Education assistance up to $5,000 per calendar year, subject to the stated one-year-of-service-after-graduation condition.
Benefit Support through Health Advocate.
Employee Assistance Program.
Flexible Spending Accounts.
Identity Theft Protection.
Pet Insurance.
Earned Wage Access.