Authorization Specialist

Undisclosed; North Platte (NE); On-site; USD 40,000 - 56,000; Full time

Job summary

Great Plains Health is hiring an Authorization Specialist to coordinate patient care across the health system. The role supports plan-of-care development, resource utilization, and communication with physicians, schedulers, and the patient financial services team.

The position focuses on ensuring medical necessity and coordinating with payers to comply with utilization and regulatory requirements. Strong terminology knowledge and CPT/ICD coding are essential for success.

Qualifications

• High School Diploma or Equivalent.
• Degree in Secretarial Administration, Health Care Administration, Business, and/or Accounting preferred.
• Knowledge of Medical Terminology, CPT and IDC codes required.

Responsibilities

• Manages individual patients across the health care continuum to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
• Acts in a leadership function with process improvement activities for populations of patients to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
• Effectively communicates the plan across the continuum of care.
• Evaluates the medical necessity and appropriateness of care, optimizing patient outcomes.
• Establishes and promotes a collaborative relationship with physicians, payers, and other members of the health care team. Collects and communicates pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. Works on denials to overthrow them.
• Educates internal members of the health care team on pre-authorizations and managed care concepts. Serve as an informational and educational resource to outside facilities i.e. nursing homes, assisted living and rehabilitation centers. Facilitates integration of concepts into daily practice.
• Acts in an educational function to help identify, collects and communicates pertinent, timely information to fulfill utilization and regulatory requirements.

Skills

Medical terminology

CPT/ICD coding

Communication

Education

High School Diploma or Equivalent

Secretarial Administration/Health Care Admin/Business/Accounting degree preferred

Job description

Great people. Great careers.

Join the team at Great Plains Health, where you can be a part of something, well, great.

Job Title:

Authorization Specialist

Cost Center:

Financial Counseling

Job Description:

This position provides comprehensive care coordination for patients as assigned. This position assesses the patient's plan of care and develops, implements, monitors and documents the utilization of resources and progress of the patient through their care, facilitating options and services to meet the patient's health care needs. The intensity of care coordination provided is situational and appropriate based on patient need and payer requirements. This position works closely with the physicians, nurses, schedulers, and patient financial services team.

Minimum Qualifications

Education

• High School Diploma or Equivalent
• Degree in Secretarial Administration, Health Care Administration, Business, and/or Accounting preferred.
• Knowledge of Medical Terminology, CPT and IDC codes required.

Credentials

• None

Work Environment

An office cubicle setting and works throughout clinical areas. Exposure to blood and body fluids, contagious diseases, medical gases, confined areas, constant use of the telephone, frequent use of the computer, and carries and uses laptop computer

Physical Demands

• Stand and/or walk frequently.
• Sit frequently.
• Lift 50 pounds frequently.
• Carry 10 pounds frequently.
• Push and/or pull 10 pounds frequently.
• Climb 1 step occasionally.
• Bend, squat, and kneel frequently.
• Reach floor-overhead frequently.
• Manual dexterity, eye hand coordination and color vision within normal limits.

Essential Functions

1. Manages individual patients across the health care continuum to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
2. Acts in a leadership function with process improvement activities for populations of patients to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
3. Effectively communicates the plan across the continuum of care.
4. Evaluates the medical necessity and appropriateness of care, optimizing patient outcomes.
5. Establishes and promotes a collaborative relationship with physicians, payers, and other members of the health care team. Collects and communicates pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. Works on denials to overthrow them.
6. Educates internal members of the health care team on pre-authorizations and managed care concepts. Serve as an informational and educational resource to outside facilities i.e. nursing homes, assisted living and rehabilitation centers. Facilitates integration of concepts into daily practice.
7. Acts in an educational function to help identify, collects and communicates pertinent, timely information to fulfill utilization and regulatory requirements.

Join us. Join great. Join the dynamic team at Great Plains Health and be a part of something truly exceptional. At Great Plains Health, we embody a culture defined by authenticity, integrity, and a genuine commitment to listening to both our patients and each other.

As a member of our team, you'll experience a supportive environment where collaboration is key, and every voice is valued. We work together seamlessly, leveraging our collective strengths to provide the highest quality care to our community.

Passion drives us forward, propelling us to constantly strive for excellence in everything we do. If you're seeking a rewarding career in healthcare surrounded by like-minded individuals who share your dedication and enthusiasm, Great Plains Health is the place for you. Come join us and be part of a team that's making a real difference every day.