System Authorization Specialist
About The Position
The Authorization Specialist position is responsible for reviewing requests for prior authorization of medical services including elective and outpatient surgeries and procedures, home health, out of network requests, and expedited requests for medical necessity in accordance with government, commercial, and workers compensation health plan coverage guidelines. This individual is responsible for benefit determination and documenting completely and accurately in accordance with healthcare system guidelines. This position works well independently solving problems and acts as liaison with others outside the department to create smooth workflows and transitions of information needed for authorizations. Promotes harmonious and efficient intra and inter departmental relationships and delivers quality customer service. Adheres to the Mission, Vision, Values and Philosophy of the departments and Saint Francis Healthcare System. Constantly works with and maintains restricted or confidential information from many sources within the healthcare system. Any and all duties as assigned by Manager and Director.
Requirements
- High school graduate or equivalent required.
- One year of experience in a healthcare setting obtaining insurance authorizations strongly preferred.
Nice To Haves
- Experience with CPT and ICD codes is a plus.
Responsibilities
- Reviewing requests for prior authorization of medical services including elective and outpatient surgeries and procedures, home health, out of network requests, and expedited requests for medical necessity in accordance with government, commercial, and workers compensation health plan coverage guidelines.
- Benefit determination
- Documenting completely and accurately in accordance with healthcare system guidelines.
- Solving problems independently
- Acts as liaison with others outside the department to create smooth workflows and transitions of information needed for authorizations.
- Promotes harmonious and efficient intra and inter departmental relationships and delivers quality customer service.
- Adheres to the Mission, Vision, Values and Philosophy of the departments and Saint Francis Healthcare System.
- Constantly works with and maintains restricted or confidential information from many sources within the healthcare system.
- Any and all duties as assigned by Manager and Director.
Benefits
- A relevant and up to date general benefits description may be found on our website: https://www.sfmc.net/careers/benefits/
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
