Authorization Specialist

Siho Holding; Columbus (IN); On-site; USD 21,000 - 32,000; Full time

Job summary

SIHO is seeking an Authorization Specialist at our Columbus, IN location. This non-exempt role supports the Medical Management Team by handling inquiries, data entry, and general administrative tasks related to the authorization process.

Responsibilities include triaging calls, ensuring accuracy of structured data, and coordinating with various departments to meet the needs of members and providers. No clinical decisions are made in this position.

Qualifications

• High School diploma or GED required; some college preferred.
• Excellent telephone skills and professional communication.
• General knowledge of Microsoft Office software.
• Knowledge of medical terminology or willingness to learn.
• Good organizational and prioritization skills.
• Ability to effectively communicate with all SIHO customers.
• Ability to work cohesively as a member of the Medical Management team.
• Willingness to be flexible and meet department needs through changes.
• Ability to consistently meet performance requirements.
• Professional appearance and presence.
• Excellent interpersonal communication in the office environment.

Responsibilities

• Responds to telephone inquiries from physician offices.
• Enter structured clinical data into the SIHO authorization system.
• Coordinate and streamline the authorization process by screening for precertification requirements.
• Triages calls to the Medical Management Department and contacts providers for UR decisions.
• Collaborates with SIHO departments to manage member and provider needs.
• Enter authorization demographic and structured clinical data and transfer requests to clinical reviewers.
• Complete non-SIHO delegated authorization entry for claims adjudication.
• Assist in educating provider offices on Medical Management processes.
• Perform Medical Management tasks that do not require clinical evaluation.
• Obtain clinical notes and contact providers as needed for daily functions.

Skills

Telephone skills

MS Office

Medical terminology

Organizational skills

Communication skills

Team collaboration

Flexibility

Performance standards

Professional appearance

Interpersonal communication

Education

High School diploma or GED

Job description

Job Details: Job Location: 417 Washington Street - Columbus, IN 47201, Job Category: Insurance, Job Title: Authorization Specialist

Reports To: Manager, Utilization Management

Job Summary

This is a non-exempt position reporting to the Manger, Utilization Management. The position is responsible for administrative activities, including responding to telephone inquiries from physician offices, entering structured clinical data into the electronic authorization system, and providing general support to the Medical Management Team. This position entails no clinical decision making.

Key Responsibilities

• Complies with local, state, and federal accreditation standards regarding the collection and data entry of structured clinical data.
• Complies with all HIPAA guidelines and regulations.
• Complies with all Medical Management and SIHO policies and procedures.
• Coordinates and streamlines the authorization process by screening for precertification requirements, eligibility, and completeness of information prior to transfer to UR for review.
• Triage incoming calls to the Medical Management Department as well as make calls to providers for UR decisions.
• Work alongside concordant departments at SIHO to effectively manage member and provider needs in a timely manner.
• Enter authorization demographic and structured clinical data into the SIHO authorization system and transfer the requests to the appropriate clinical reviewer.
• Complete non-SIHO delegated authorization entry in the authorization system for claims adjudication.
• Assists in education of provider offices regarding Medical Management processes.
• Performs Medical Management functions that do not require evaluation or interpretation of clinical data.
• Obtains clinical notes and contacts providers as needed in assistance to Utilization Managers for daily functions and care planning.

Minimum Skills Requirement

• High School diploma or GED required, some college preferred
• Excellent telephone skills
• General knowledge of Microsoft Office software
• Knowledge of medical terminology or willingness to learn
• Good organizational and prioritization skills that are primarily self-directed
• Ability to effectively communicate with all SIHO customers
• Ability to work cohesively as a member of the Medical Management team
• Willingness to be flexible and meet the needs of the department and corporation through changes
• Ability to consistently meet performance requirements
• Professional appearance and presence
• Ability to maintain excellent interpersonal communication in the office environment

Other

• Confirmation of excellent attendance record
• General Knowledge and understanding of an office environment

Qualifications: Minimum Skills Requirement

• High School diploma or GED required; some college preferred
• Excellent telephone skills
• General knowledge of Microsoft Office software
• Knowledge of medical terminology or willingness to learn
• Good organizational and prioritization skills that are primarily self-directed
• Ability to effectively communicate with all SIHO customers
• Ability to work cohesively as a member of the Medical Management team
• Willingness to be flexible and meet the needs of the department and corporation through changes
• Ability to consistently meet performance requirements
• Professional appearance and presence
• Ability to maintain excellent interpersonal communication in the office environment

Other

• Confirmation of excellent attendance record
• General Knowledge and understanding of an office environment