Authorization Specialist

Hemet Global Medical Center; Santa Ana, Northern (CA, KY); Hybrid; USD 30,000 - 51,000; Full time

Job summary

Hemet Global Medical Center 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 involves contacting insurance companies, reviewing discharge authorizations, obtaining missing authorizations within required timeframes, and maintaining accurate documentation and reporting.

Qualifications

• High school diploma or equivalent or combination of experience and education.
• Minimum of two (2) years of experience in scheduling, authorization and referrals in a health care setting.
• Strong attention to detail.
• Excellent communications skills both oral and written.
• Excellent follow up and follow through skills.

Responsibilities

• 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 entry in the system.
• Obtain missing authorizations within 3 business days of discharge or within 7 days of admission.
• Check bill hold weekly for pending authorizations.
• Assist with sending delinquent reviews and resending reviews not received by Payors.
• Maintain professional relationships with Case Management and departments impacting authorizations.
• Analyze authorization issues by payer and report monthly to leadership.
• Document all authorizations in the hospital system per required format.

Skills

Attention to detail

Excellent communication

Follow up

Education

High school diploma or equivalent

Job description

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