Authorization Specialist I

Current Saint Francis Employees - Please click HERE to login and apply.

Job Summary: The Authorization Specialist I directly impacts the billing and collections functions of the revenue cycle by ensuring accuracy of insurance information and procuring prior authorization and predetermination for scheduled patient appointments as well as inpatient admissions. Timely facilitation of insurance approval contributes to the accuracy of patient estimates and pre-service collections, patient ease of access to care and serves to prevent denials of claims submitted for payment. Authorization Specialists do not have leadership responsibilities, but are expected to perform duties with a high degree of independence, meeting productivity and quality metrics consistently.

Minimum Education: High School Diploma or GED.

Licensure, Registration and/or Certification: None.

Work Experience: 1 - 2 years relevant experience. 1 year of benefits verification or authorization experience or 2 years of pre-registration experience. Post-secondary education may be substituted for 1 year of experience.

Knowledge, Skills and Abilities: Basic healthcare and insurance terminology. Basic computer knowledge and skills.  Proficient with office machines, including fax, copier and scanner.  Ability to navigate insurance websites to access patient, eligibility and payment information.  Good communication skills - written and verbal.  Phone-based contact center skills involving multiple-line phone systems.  Employee must possess the ability to organize and prioritize work; must be detail oriented.  Understanding of a professional business environment.  Basic knowledge of medical billing and insurance follow-up activity.

Essential Functions and Responsibilities: Monitors patient and/or referrals and/or denials work queues to determine encounters that require pre-registration, verification, authorization, or corrections to ensure proper billing. Works encounters according to assignment and consistently meets daily and weekly productivity goals. Evaluates physician referral and authorization requirements and takes appropriate steps to ensure requirements are met prior to date of procedure. Reviews clinical documentation for CPT/diagnosis code information to support authorization/precertification according to payer guidelines. Accurately monitors, reviews and processes authorizations and validates the requests are accurate, within the required timeline, and in compliance with the applicable insurance guidelines. Coordinates as needed with other departments/ancillary areas for special needs or resources. Counsels clinical partners and/or patients to facilitate additional information when required by payer. Coordinates with patient, referring physician's office and/or referring location, scheduled service area, financial counselors, case manager, and others as appropriate to obtain additional information or provide information on patients' financial status. Documents pertinent information and efforts in computer system based upon department documentation standards. Protects the privacy and security of patient health information to ensure that confidentiality is maintained.

Decision Making: Independent judgment in planning sequence of operations and making minor decisions in a complex technical or professional field.

Working Relationship: Works directly with patients and/or customers. Works with internal and/or external customers via telephone or face to face interaction. Works with other healthcare professionals and staff.

Special Job Dimensions: None.

Supplemental Information: This document generally describes the essential functions of the job and the physical demands required to perform the job.  This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.

Location: