Authorization Specialist

Valley Health Partners; Allentown (Lehigh County); On-site; USD 40,000 - 55,000; Full time

Benefits offered by this job

Medical, dental, and vision plans

403b Retirement Plan

Paid Time Off

Employee Assistance Program

Tuition Reimbursement

Job summary

Valley Health Partners is seeking an Authorization Specialist at their Center of Hope in Allentown, PA. The role involves obtaining necessary benefits and authorizations for various medical services.

Candidates should have at least a high school diploma, with specialized training in insurance or billing preferred. The position requires strong communication with insurance companies and collaboration with healthcare professionals to ensure medical necessity and compliance with policies.

Qualifications

• 1 year in a healthcare setting with insurance verification/authorizations is required.
• Specialized training in insurance, coding, billing, or similar healthcare certificate programs.

Responsibilities

• Collaborates with physicians to ascertain appropriate authorization.
• Performs medical necessity checks for procedures.
• Communicates with insurance companies for verification and approval.
• Verifies clinical information and insurance authorizations.
• Maintains compliance with benchmark data.

Skills

Billing procedures familiarity

Knowledge of patient rights

Utilization management proficiency

Standard medical practices knowledge

Education

High School Diploma/GED

Associate’s degree preferred

Job description

Authorization Specialist, Center of Hope

Valley Health Partners, Allentown, PA

Job Summary:

Obtains benefits and authorizations for surgical procedures, diagnostic testing, medications, outgoing referrals, and other services as part of daily operations. Determines the authorization protocols for each health plan and performs billing duties to ensure proper and timely payment is received from insurance carriers and patients.

Qualifications:

Education:

• High School Diploma/GED with specialized training in insurance, coding, billing, or similar healthcare certificate programs. Associate’s degree preferred.

Experience:

• 1 year in a healthcare setting with insurance verification/authorizations can be substituted in lieu of specialized training.

Skills Needed:

• Familiarity with billing procedures and payer reimbursement.
• Knowledge of patient rights and laws relative to those rights, such as HIPAA.
• Proficient in utilization management processes, standards, and managed care.
• Proficient in standard medical practices and insurance benefit structures

Essential Functions:

• Collaborates with physicians and provider office staff in ascertaining the appropriate authorization based on medical necessity and the treatment plan provided.
• Performs a medical necessity check to determine if procedure and diagnosis support medical necessity.
• Ensures authorizations are obtained in accordance to network policy (any authorization not falling into policy guidelines is communicated to ordering office, patient, and manager).
• Communicates direct/indirect with insurance companies to obtain insurance verification, benefits and precertification for approval.
• Verifies additional clinical information and insurance authorizations/referrals.
• Reviews and monitors WQs/schedules to ensure that proper and accurate authorization has been received prior to patient’s visit.
• Maintains compliance with benchmark data regarding accounts registered versus scheduled procedures.
• Determines estimated patient financial responsibility using insurance verification information and payer contracts and/or self-pay guidelines.
• Takes on other duties as assigned

  • Benefits:

    • Choice of medical, dental, and vision plans with great coverage at VERY affordable rates.
    • 403b Retirement Plan with generous company match
    • Paid Time Off for holidays, vacation, sick & personal days
    • Employee Assistance Program
    • Tuition Reimbursement

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.