Job details

Authorization Specialist - Neuroscience Institute

Get a free resume review

Wage Range: $23.25 - $37.20 per hour

Posted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity.

Job Summary:
Expedites the administrative requirements for patient care, including clinical authorizations based on specialty provider orders, dealing directly with health plans. Makes decisions and authorizes risk planning referrals, utilizing department and organizational guidelines. Requires daily interaction with patients, staff, healthcare providers, and insurance companies. All job functions are carried out within the EvergreenHealth Medical Group clinic(s) to which assigned.

Primary Duties:
1. Accurately and successfully processes authorizations for medications, procedures, imaging, infusions, surgeries, etc. ordered by clinic providers by working directly with health plans.
2. Minimizes care delays by avoiding denials and peer-to-peer escalation between payers and providers.
3. Maintains written best practice guidelines for each service and each payer, expanding on the contracted payer list to include coverage requirements, documentation, and authorization submission requirements for successful approval.
4. Serves as main point of contact and escalation point for clinical and non-clinical colleagues regarding insurance authorizations.
5. Develops and provides clinic staff training on insurance plan requirements and coverage for authorization of medications, procedures, imaging, infusions, etc.
6. Educates and periodically reviews workflow related to non-covered services, price quotes, etc. with front office staff.
7. Maintains charge masters for department, including fee structure, and makes recommendations for changes to the management team.
8. Addresses and resolves patient complaints regarding charges by liaising with Professional Billing and Patient Financial Services on behalf of the patient, including following up with patients directly.
9. Attends and participates in all departmental meetings and activities.
10. Answers phone lines in support of care coordination when needed.
11. Backs up front and back-office colleagues with records requests, chart prep, scanning, scheduling, and other admin care coordination work when needed for patient flow and safety.
12. Performs other duties as assigned.

REQUIRED:
• Associate degree or equivalent combination of education and experience
• 3 years of experience in a healthcare insurance or related medical office setting
• General clinical knowledge related to medications, procedures, imaging, infusions, etc.
• Working knowledge of ICD10 and CPT codes
• Working knowledge of insurances, Medicare, DSHS, Labor and Industries, and other third-party insurances
• Medical Terminology, medical billing, and computer skills
• Ability to be flexible and relate well with others in a professional and pleasant manner
• Knowledge of medical records confidentiality
• Excellent communication skills with a high degree of tact and poise to deal effectively with patients, physicians, and hospital staff members

DESIRED for the position:
• Recent specialty clinic authorization experience for medications, procedures, imaging, infusions, surgeries, etc.

Benefit Information:
Choices that care for you and your family

At EvergreenHealth, we appreciate our employees’ commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.

• Medical, vision and dental insurance
• On-demand virtual health care
• Health Savings Account
• Flexible Spending Account
• Life and disability insurance
• Retirement plans (457(b) and 401(a) with employer contribution)
• Tuition assistance for undergraduate and graduate degrees
• Federal Public Service Loan Forgiveness program
• Paid Time Off/Vacation
• Extended Illness Bank/Sick Leave
• Paid holidays
• Voluntary hospital indemnity insurance
• Voluntary identity theft protection
• Voluntary legal insurance
• Pay in lieu of benefits premium program
• Free parking
• Commuter benefits

View a summary of our total rewards available to you as an EvergreenHealth team member by clicking on the link below.

EvergreenHealth Benefits Guide

Average salary estimate

$62793 / YEARLY (est.)

min

max

$48330K

$77256K

If an employer mentions a salary or salary range on their job, we display it as an "Employer Estimate". If a job has no salary data, Rise displays an estimate if available.

What You Should Know About Authorization Specialist - Neuroscience Institute, EvergreenHealth

Are you ready to take your career in healthcare to the next level? Join the Neuroscience Institute as an Authorization Specialist! At EvergreenHealth, we’re all about putting patients first, and your role will be pivotal in expediting essential administrative tasks that impact patient care. This position involves handling clinical authorizations based on specialty provider orders and engaging directly with health plans. You’ll be making important decisions on risk planning referrals, all while working within a collaborative team environment. As the main point of contact for staff and healthcare providers on insurance authorizations, you’ll ensure that medication, procedures, imaging, and surgeries are processed efficiently and without delays. Your knack for understanding clinical workflows and regulations will help you maintain best practice guidelines and train clinic staff on insurance coverage requirements. With a focus on delivering great patient outcomes, you’ll also manage charge masters and resolve any patient billing inquiries. Seeking an opportunity that values education? You've got it! EvergreenHealth offers a comprehensive benefits package designed to enhance your and your family’s well-being. We’re excited to have you join our team, where no two days are alike, and your contributions truly matter.

Frequently Asked Questions (FAQs) for Authorization Specialist - Neuroscience Institute Role at EvergreenHealth

What are the responsibilities of an Authorization Specialist at EvergreenHealth?

As an Authorization Specialist at EvergreenHealth, your main responsibilities include processing authorizations for various clinical services, minimizing care delays, developing staff training on insurance requirements, and serving as a point of contact for authorization-related queries. You'll work closely with health plans and healthcare providers to ensure seamless patient care.