[Hiring] Procedure Authorization Specialist @Healthcare Outcomes Performance Company

Role Description

• Monitors the authorizations of upcoming surgical cases on the physician’s calendars ensuring authorizations for surgeries are obtained in a timely and accurate manner.
• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms necessary information to allow processing of claims to insurance plans.
• Accurately completes surgical cost analysis form, documenting the required surgical cost estimation for collection prior to services.
• Verifies benefits on all surgical procedures.
• Documents authorizations and progress of authorizations in the patient’s chart. Enters the authorization information within case management.
• Must be able to communicate effectively with physicians, patients, and co-workers and be capable of establishing good working relationships with both internal and external customers.
• Participates in providing ongoing training and education of staff as it relates to new processes to ensure timely confirmation of surgical cases.
• Works with department manager to respond to and reduce complaints timely and professionally.
• Assists surgery schedulers with STAT authorizations.
• Ensures strict confidentiality of all health records, member information and meets HIPAA guidelines.
• Assists in identifying opportunities for improvement within the daily workflow process.
• Attends department meetings as required.

Qualifications

• High school diploma/GED or equivalent working knowledge preferred.
• A minimum of 2 years of experience in the healthcare field is required and previous experience in referrals/authorizations, front office, and/or charge posting is preferred.
• Excellent organizational skills and strong customer service orientation are required with a strong background in computers and data entry.

Requirements

• Working knowledge of eligibility, verification of benefits, and prior authorizations from various HMOs, PPOs, commercial payers, and other funding sources.
• Knowledge of federal, state, and HIPAA privacy regulations.
• Knowledge of computer applications.
• Skill in effective organization and billing requirements and authorization processes.
• Skill in using computer programs and applications including Microsoft Excel, Microsoft Word, and Outlook.
• Skill in establishing good working relationships with both internal and external customers.
• Ability to multi-task in a fast-paced environment. Must be detail-oriented with strong organizational skills.
• Ability to understand patient demographic information and determine insurance eligibility.
• Ability to work independently and demonstrate the ability to analyze data.
• Ability to communicate effectively and compassionately with patients, co-workers, management, and providers.

Environmental Working Conditions

• Normal office environment.

Physical/Mental Demands

• Requires sitting and standing associated with a normal office environment.
• Some bending and stretching are required.
• Manual dexterity using a calculator and computer keyboard.

Organizational Requirements

• HOPCo Mission, Vision, and Values must be read and signed.
• This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as needs evolve.