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Central Authorization Specialist

Visiting Physicians Association

This is a Full-time position in Troy, PA posted October 24, 2021.

Jobs and Careers at the U.S.

Medical Management Talent Network

U.S.

Medical Management (USMM) is an affiliate of a leading Fortune 100 company.

A national organization built on a continuum of care with premier healthcare providers, clinicians and patient focused individuals working together.

Our Mission – “Through Compassionate Patient-Centered Care in the Home; We will Provide Exceptional Outcomes across our Continuum of Services” – Visiting Physicians Association, Pinnacle Senior Care, Grace Hospice, Comfort Hospice, Home DME & our In Home Health Assessments (IHA).

Our Values of Integrity, Respect, Teamwork & Excellence are leading us to a better tomorrow for patient care.

Our Purposes Centered on “We are Unified in our Work through our Continuum of Services” “We can Find Comfort that We are Making a Difference for our Patients” & “We make a Broader Positive Impact on Society”, allows USMM to be poised for a phenomenal future.

We are seeking candidates who desire the experience of delivering quality & compassionate healthcare within proven care models with patients at the forefront of everything we do.

Benefits We Have to Offer: 

  • Health, Dental, Vision, Disability & Life Insurance
  • 401K Retirement Plan
  • Paid Holidays
  • PTO 
  • Flexible Spending Account
  • Tuition Reimbursement

Position Description

The Central Authorization Specialist coordinates and processes all new and subsequent authorizations through verification of insurances, acquiring and entering accurate patient demographic and billing information, and submitting all insurance authorization requests in a timely and accurate manner as required by the payor.

Essential Duties and Responsibilities

  • Complete all authorization related workflow tasks as required
  • Verifies and accurately interprets patient benefits via online portals or telephone
  • Timely and accurately enters all authorization numbers in billing system
  • Completes all necessary items required to finalize pending authorizations; subsequently updates billing system with relevant changes to authorization status, frequency and effective dates
  • Interpret chart notes in order to facilitate obtaining authorizations
  • Collaborate with internal and external customers for a seamless authorization process
  • Submits all re-authorization requests for additional or subsequent services.

    Tracks and follows up on all re-authorizations in same manner as initial authorization

  • Communicate to clinical and office staff updates regarding authorization feedback to promote continuous improvement
  • Responds to all email and phone requests in a timely and professional manner
  • Monitor monthly authorization denial volume and work to improve department performance
  • Meet established service level agreement for authorization turnaround time and quality
  • Understanding of patient treatment plans for purpose of obtaining authorizations
  • Serve as the subject matter expert for insurance authorization and verification
  • Performs miscellaneous job-related duties as assigned

REQUIRED Knowledge, Skills and Experience

  • High School Diploma
  • 2 years of related experience
  • Maintain high-level confidentiality to sensitive data, HIPAA, etc.
  • Familiar with multi state insurance verification requirements
  • Ability to research and maintain multi-state insurance authorization requirements
  • Ability to interpret insurance records and related documentation
  • Organizational and time management skills, as evidenced by capacity to prioritize multiple tasks
  • Clear understanding in Microsoft Excel and Outlook
  • Strong attention to detail, accountability, organizational and interpersonal skills
  • Ability to partner with shared stakeholders to achieve mutual success
  • Ability to work in fast paced environment
  • Strong accountability to team environment
  • Excellent communication and organizational skills, verbal and written (end user support documentation, policies and procedures, etc.)
  • Work independently and exercise sound judgment in interactions with physician, payors, and patients and their families if required

Preferred Knowledge, Skills and Experience

  • Additional coursework in health care administration, billing or medical terminology
  • 3 years of experience in a medical clinic setting or training in a medical office or hospital setting
  • 2 years of experience related to healthcare insurance verification and/or billing
  • Knowledge of clinical terminology and coding
  • General understanding of revenue cycle with an emphasis on billing, coding, charge capture and reimbursement