Authorization Specialist I - Saint Paul
6 days ago
Responsibilities Review medical chart/history and physician order(s) to determine likely ICD and CPT codes and/or utilize available coding resources Screen payer medical policies to determine if the service meets medical necessity guidelines Review and determine appropriate clinical documentation to submit to ensure a complete authorization request Submit and manage authorization requests and/or ensure that pre-certification and admission and discharge notification requirements are met per payer guidelines Facilitate insurance denial mitigation steps such as peer-to-peer reviews and appeals in conjunction with revenue cycle care teams utilization review patients/guarantors Maintain knowledge of current payer requirements general ordering/admitting practices including use of online payer applications initial/ongoing training Collaborate with all necessary stakeholders minimize financial risk ensure best possible outcome each patient Use transparent thoughtful communication critical thinking multi-tasking time management prioritization skills ensure successful completion duties including presentations meeting facilitation Adapt rapid changes workflow leader direction utilize available resources problem solve troubleshoot independently capitalize constructive feedback enhanced outcomes Complete timely accurate work contribute process enablement collecting expected payment Understand/adhere Revenue Cycle Escalation Policy work collaboratively achieve personal team organization metric behavioral goals Demonstrates ability provide care/service adjusting approaches reflect developmental level cultural differences population served Partners patient caregiver care/decision making Communicates respective manner Ensures safe secure environment Individualizes plan care meet patient needs Modifies clinical interventions based population served Provides patient education assessment learning needs patient/caregiver Fulfills organizational requirements Completes required learning relevant role Complies maintains knowledge relevant laws regulations policies procedures standards Fosters culture improvement efficiency innovative thinking Performs other duties assigned Qualifications
- Associate degree business healthcare related area. 2 years revenue cycle experience may substitute associate degree.
- 1 year experience working revenue cycle insurance verification financial securing related areas using EHR enterprise software system healthcare organization.
Job description
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