Authorization Specialist

Riverview Health; Noblesville (IN); Hybrid; USD 38,000 - 52,000; Full time

Job summary

Riverview Health in Noblesville, IN is seeking an Authorization Specialist to manage payer authorizations for scheduled services and ensure alignment with payer contracts.

You will verify insurance benefits, obtain prior authorizations, gather demographic and clinical information, and update the EMR as needed.

The role requires HIPAA compliance, professional communication with patients and payers, and collaboration with departments to resolve authorization issues.

Qualifications

• Minimum: Associate degree in healthcare or business administration and/or related coursework, or comparable experience.
• Preferred: Epic experience.

Responsibilities

• Verifies patients’ insurance and benefits information.
• Obtains prior authorizations from third-party payers according to requirements.
• Gathers demographic and insurance information from patients and updates EMR.
• Gathers clinical information from departments to support authorization.
• Develops price estimates for patient out-of-pocket responsibility.
• Refer accounts to financial counseling when authorization is not obtained.
• Supports appeal efforts for authorization-related denials.
• Reviews schedules to ensure Medicare IP-only procedures have the proper authorization.
• Complies with HIPAA regulations and Riverview Health policies.
• Mantains a professional tone when communicating with patients and payers.
• Coordinates re-education to practices/departments when orders are incorrect.
• Performs other duties as requested.

Skills

Insurance verification

Prior authorizations

EMR data entry

Patient communication

Denials appeal support

HIPAA compliance

Interdepartmental coordination

Education

Associates degree in healthcare or business administration

Tools

Epic

Job description

The Authorization Specialist is responsible for ensuring that payers are prepared to reimburse Riverview Health for scheduled services in accordance with the payer-provider contract. The Specialist contacts payers to request service authorization and may collect clinical, financial and/or demographic information from clinics, hospital departments and/or patients as needed.

Job Responsibilities

• Verifies patients’ insurance and benefits information
• Obtains prior authorizations from third-party payers in accordance with payer requirements. Identifies patients who will need to receive Medicare Advance Beneficiary Notices of Noncoverage (ABNs).
• Contacts patients to gather demographic and insurance information as needed, and updates patient information within the EMR as necessary.
• Works with other departments to gather the clinical information required by the payer to authorize services. Maintains accurate records of authorizations within EMR.
• Develops price estimates for patient out-of-pocket responsibility.
• Refers accounts to financial counseling as needed if authorization is not obtained. Works with business office staff to support appeal efforts for authorization-related denials.
• Reviews surgery schedules to ensure Medicare patients with IP-only procedures have the appropriate authorization and order.
• Complies with HIPAA regulations, as well as Riverview Health policies and procedures regarding patient privacy and confidentiality.
• Maintains professional tone at all times when communicating with patients and payer representatives.
• Coordinates re-education to practices or hospital departments when orders are incorrect or not supported by the given diagnosis.
• Performs other duties as requested.

Education Requirements

• Minimum: Associate degree in healthcare or business administration and/or related coursework, or comparable experience
• Preferred: Experience in Epic

Experience Requirements

• Minimum: Two years of experience in a healthcare setting performing related tasks
• Preferred: Five years of experience in a healthcare setting performing related tasks

License/Certification Requirements

• None

Qualifications

Education

Required

Associates or better in Other.

Equal Opportunity Employer
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