| Location | Troy, MI |
The purpose of the Central Authorization Specialist position is to centrally facilitate the successful procuring of insurance authorizations for ordered procedures and post-operative care. This will be done through quality validations of obtained authorizations as well as continuous education and opportunity feedback to a multi-disciplinary team with the underlying objective of managing the cost of care and providing timely and accurate information to payors. The Central Authorization Specialist helps drive change by identifying areas where performance improvement is needed (e.g., day to day workflow, education, process improvements, patient satisfaction). The Central Authorization Specialist is accountable for a designated caseload and plans effectively in order to meet demands and support resources procuring authorizations. Under general supervision and in accordance with established policies and procedures the specific functions within this role include Subject matter expertise of precertification and payor authorization processes. Ensure successful authorizations are procured by ordering physician offices through validation of work effort and education of procuring staff. Ensure feedback relevant to successful authorization procurement is obtained from back-end coding, billing and denial management resources and distributed to ordering physicians and authorization procurement staff to promote continuous improvement. Application of process improvement methodologies. The responsibilities include acting as a centralized resource for assigned specialty across all sites of practice to ensure standardized and consistent procurement of authorizations.
Education: High school diploma or equivalent combination of education and experience
Experience: 3-5 years in a medical clinic, hospital, or corporate setting
Insurance/Billing: 2+ years of healthcare insurance verification and/or billing experience
Authorizations: Experience obtaining insurance authorizations and understanding patient treatment plans
Clinical Knowledge: Ability to interpret RN/physician notes and understand clinical terminology
Coding: Knowledge of medical coding and revenue cycle processes
Insurance: Ability to interpret insurance records and related documentation
Preferred Experience:
Medical or surgical specialty clinic
Hospital operations
Utilization/case management
Managed care reimbursement
Billing, coding, charge capture, and reimbursement
Technology: Highly computer literate with strong data management skills
Organization: Strong time management and ability to prioritize multiple tasks
Communication: Strong verbal, written, interpersonal, and negotiation skills
Collaboration: Ability to work effectively with physicians, clinicians, payors, finance teams, management, and patients
Judgment: Ability to work independently, identify roadblocks, and communicate additional requirements effectively
Preferred Education: Coursework in business, computers, or healthcare administration
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