Authorization Specialist
great plains healthNorth Platte (NE)
About the role
Authorization Specialist This position provides comprehensive care coordination for patients as assigned. This position assesses the patient's plan of care and develops, implements, monitors and documents the utilization of resources and progress of the patient through their care, facilitating options and services to meet the patient's health care needs. The intensity of care coordination provided is situational and appropriate based on patient need and payer requirements. This position works closely with the physicians, nurses, schedulers, and patient financial services team.
Minimum Qualifications
Education:
High School Diploma or Equivalent Degree in Secretarial Administration, Health Care Administration, Business, and/or Accounting preferred. Knowledge of Medical Terminology, CPT and IDC codes required.
Credentials: None
Work Environment:
An office cubicle setting and works throughout clinical areas. Exposure to blood and body fluids, contagious diseases, medical gases, confined areas, constant use of the telephone, frequent use of the computer, and carries and uses laptop computer
Physical Demands:
Stand and/or walk frequently. Sit frequently. Lift 50 pounds frequently. Carry 10 pounds frequently. Push and/or pull 10 pounds frequently. Climb 1 step occasionally. Bend, squat, and kneel frequently. Reach floor-overhead frequently. Manual dexterity, eye hand coordination and color vision within normal limits.
Essential Functions:
Manages individual patients across the health care continuum to achieve the optimal clinical, financial, operational, and satisfaction outcomes. Acts in a leadership function with process improvement activities for populations of patients to achieve the optimal clinical, financial, operational, and satisfaction outcomes. Effectively communicates the plan across the continuum of care. Evaluates the medical necessity and appropriateness of care, optimizing patient outcomes. Establishes and promotes a collaborative relationship with physicians, payers, and other members of the health care team. Collects and communicates pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. Works on denials to overturn them. Educates internal members of the health care team on pre-authorizations and managed care concepts. Serve as an informational and educational resource to outside facilities i.e. nursing homes, assisted living and rehabilitation centers. Facilitates integration of concepts into daily practice. Acts in an educational function to help identify, collects and communicates pertinent, timely information to fulfill utilization and regulatory requirements.
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