JOB SUMMARY
The Authorization Specialist is a healthcare professional responsible for reviewing patient medical records to determine if a prescribed treatment, procedure, or medication requires prior authorization from the insurance company, ensuring that the requested care is deemed medically necessary and covered under the patient's benefits before it can be administered; this involves verifying patient eligibility, contacting insurance companies to obtain authorization, and managing the process to minimize delays in patient care. An Authorization Specialist works in a fast-paced environment with high call volumes, requiring strong organizational skills and the ability to manage multiple tasks simultaneously.
JOB QUALIFICATIONS
EDUCATION
For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation.
Minimum Required: None
Preferred/Optional: Successful completion of post-secondary courses in Medical Terminology and Diagnosis and CPT Coding, and Anatomy & Physiology. Graduate of a Medical Assistant, Health Unit Coordinator or Health Care Business Service program.
EXPERIENCE
Minimum Required: Two years’ experience in a medical business office or healthcare setting involving customer service or patient-facing responsibilities, or equivalent experience. In addition to the following:
Medical knowledge: Understanding of basic medical terminology, disease processes, and treatment options to accurately assess medical necessity.
Insurance knowledge: Familiarity with different insurance plans, benefit structures, and prior authorization guidelines.
Excellent communication skills: Ability to effectively communicate with healthcare providers, insurance companies, and patients to clarify information and address concerns.
Attention to detail: High level of accuracy in data entry and review of medical records to ensure correct prior authorization requests.
Problem-solving skills: Ability to identify potential issues with prior authorization requests, navigate complex situations, and find solutions to ensure timely patient care.
Preferred/Optional: None
CERTIFICATIONS/LICENSES
The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position.
Minimum Required: None
Preferred/Optional: None
Given employment and/or payroll requirements of individual states, Marshfield Clinic Health System supports remote work in the following states:
Alabama
Alaska
Arkansas
Florida
Georgia
Idaho
Illinois (except Chicago)
Indiana
Iowa
Kansas
Kentucky
Michigan
Minnesota
Mississippi
Missouri
Nebraska
North Carolina
North Dakota
Ohio
Oklahoma
South Carolina
South Dakota
Tennessee
Texas
Utah
West Virginia
Wisconsin
Wyoming
Marshfield Clinic Health System will not employ individuals living in states not listed above.
Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first.
Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.
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