Authorization Specialist

KPC Health, Inc.; Santa Ana (CA); Sur place; USD 31 000 - 52 000; Plein temps

Résumé du poste

KPC Health, Inc. in Santa Ana, CA is seeking an Authorization Specialist to ensure timely verification and validation of authorizations for Commercial and Managed Care inpatients and other services.

The role requires contacting insurance companies, reviewing discharged patients for authorization entries, and obtaining missing authorizations within defined timeframes. The position emphasizes accurate documentation and cross‑department collaboration.

Qualifications

• High school diploma or equivalent.
• Minimum of two (2) years of experience in scheduling, authorization and referrals in a health care setting.

Responsabilités

• Verify and validate authorizations for Commercial and Managed care inpatients and other services.
• Contact insurance companies by phone or website to secure authorization.
• Review discharged managed care patients for authorization entries in the system.
• Obtain missing authorizations within 3 business days of discharge or within 7 days of admission in some cases.
• Check bill hold weekly for pending authorizations.
• Assist with sending delinquent reviews and resending reviews not received by payors.
• Communicate with Case Management and other departments to obtain authorizations.
• Maintain analysis of authorization issues by payer and report monthly to senior leadership.
• Document all contacts and authorization information in the hospital system per documentation standards.
• Follow hospital policies and procedures regarding authorization processes.
• Other duties as assigned.

Connaissances

Attention to detail

Communication skills

Follow-up skills

Formation

High school diploma

Description du poste

Authorization Specialist

Full Time KPC SANTA ANA, Santa Ana, CA, US

Salary Range: $22.38 To $37.74 Hourly

SUMMARY

Ensures timely verification and validation of authorizations for all Commercial and Managed care inpatients and other services as assigned.

Duties/Responsibilities:

• Ensure timely verification and validation of authorizations for all Commercial and Managed care inpatients and other services as assigned.
• Contacts insurance companies via phone or website to secure authorization.
• Responsible to review all discharged managed care patients for evidence of authorization entry in the Authorization module.
• Obtains missing authorizations within 3 business days of patient’s discharge or in some cases within 7 days of admission.
• Responsible for checking bill hold weekly for pending authorizations.
• Assists with sending delinquent reviews and resending reviews not received by the Payors.
• Communicate effectively, build and maintain professional, cooperative relationships with Case Management and all departments that have direct or indirect impact on obtaining authorizations.
• Maintains analysis of authorization issues, by payer.
• Reports monthly summary for authorization issues to senior leadership.
• Clearly documents all contacts and authorization information for all types of authorizations in the hospital system, complete standardized documentation requirements in expected format.
• Follows established hospital policies and procedures regarding authorization processes.
• Other duties as assigned.

Education and Experience:

• High school diploma or combination or relevant experience and education
• Minimum of two (2) years of experience in a scheduling, authorization and referrals in a health care setting

Required Skills/Abilities:

• Strong attention to detail
• Excellent communications skills both oral and written
• Excellent follow up and follow through skills