Authorization Specialist

TidalHealth, Inc.; Maryland; Hybrid; USD 52,000 - 76,000; Full time

Benefits offered by this job

Health insurance

403(b) matching

Tuition assistance

Generous PTO and Holidays

Onsite Child Care

Pet Insurance

Employer-paid Short-Term Disability

Long-Term Disability

Job summary

The Authorization Specialist at TidalHealth Atlantic in Berlin, MD monitors and submits insurance authorizations across prior service, surgical, acute hospital, and post-acute care needs to align with medical necessity policies.

Collaborating with Case Managers, Utilization RNs, physicians, insurers, and discharge planners, this role also handles non-clinical tasks like invoicing, pre-authorizations, and benefit verification to streamline patient care.

Qualifications

• Bachelor’s degree in health-related field or equivalent medical office experience required.
• Minimum of three (3) years clinical/medical office and/or related experience required.
• Working knowledge of ICD Diagnostic Codes and medical terminology.

Responsibilities

• Monitor and submit all insurance authorizations including prior service, surgical, acute hospital, and post-acute care authorizations.
• Collaborate with Case Managers, Utilization RNs, physicians, insurance companies, finance, patients, providers, and authorization process stakeholders to reduce length of stay and ensure appropriate use of benefits.
• Maintain and follow up on non-clinical administrative tasks related to utilization review, discharge planning, PCP appointments, regulatory paperwork, invoicing, prior authorizations, and benefit verification.
• Track and document appeal/denial activity and case documentation.

Skills

Microsoft Excel

Microsoft Outlook

Microsoft Word

ICD codes

Education

Bachelor's degree in health-related field

Job description

Authorization Specialist

• Location Berlin, MD
• Facility TidalHealth Atlantic
• Department Patient Care Management
• Schedule - Shift - Hours Full Time - Monday - Friday - 8am to 4:30pm/ 830am to 5p (8 hrs)

Join a triple 'A' rated team where clinical excellence meets a coastal lifestyle. At TidalHealth, you’ll be part of an award-winning network spanning Maryland and Delaware, recognized by the Leapfrog Hospital Safety Guide for our unwavering commitment to patient care. Whether your expertise lies in specialized clinical fields like neurosurgery, academic mentorship through our graduate medical programs, or the critical professional and support roles that keep our network thriving, we provide the tools and tuition assistance you need to excel.

Authorization SpecialistPosition Summary

The Authorization Specialist is responsible and accountable for monitoring and submitting all insurance authorizations including but not limited to; prior service, surgical, acute hospital, and post-acute care authorizations, that may include rehabilitation, transportation, medication, durable medical equipment, and home service authorizations that align with medical necessity policies and regulatory requirements for TidalHealth. The Authorization Specialist works collaboratively with Case Managers, Utilization RNs, physician advisors, insurance companies, finance, patients, providers, and authorization process stakeholders, to reduce length of stay, ensure fiscal responsibility, appropriate use of benefits, and streamlining the discharge process. They will also be responsible for maintaining and following up on non-clinical administrative tasks related to utilization review, discharge planning, PCP appointments, regulatory paperwork, invoicing, prior authorizations, benefit verification preservice review, healthcare claims inquiry, appeal/denial tracking, and case documentation.

Authorization Specialist Position Requirements

Education:

• Bachelor’s degree ina health-related field or equivalent medical office experienceis required.

Experience:

• Minimum of three (3) years clinical/medical office and/or related experience required.
• Working knowledge of Microsoft applications, primarily Excel, Outlook and Word is required.
• Working knowledge of ICD Diagnostic Codes and medical terminology.

Schedule:

• Primarily day shift, Monday through Friday

Benefits: We provide a robust benefits suite for our eligible team members (36+ hours for 12-hour shifts; 37.5+ hours for standard shifts):

• Health:Medical (including HSA), Dental, Vision, & Prescription
• Wealth:Matching 403(b), Healthcare FSAs, & Dependent Care FSAs
• Growth:$5,000 Tuition Assistance & Certification support
• Balance:Generous PTO and Holidays, Onsite Child Care, Pet Insurance
• Income Protection & Leave:Employer-Paid Short-Term Disability, Paid Leave Program, & Long-Term Disability (LTD for FT)
• Life & Security:Employer-paid Life andadditionalvoluntary benefits such as Accident, Critical Care,additionalLife, and more

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TidalHealth offers the best inpatient-centered care across the Delmarva Peninsula, from wellness checkups and classes tohigh-techsurgeries, trauma, cancer and heart care. Wherever you are on your health journey, we’rehere to care foryou.