Authorization Specialist

Westchester Medical Center Health Network; Town of Mount Pleasant (NY); On-site; USD 52,000 - 68,000; Full time

Job summary

Westchester Medical Center Health Network is seeking an Authorization Specialist to perform complex clerical work coordinating insurance verification and authorizations for inpatient admissions and specialized procedures, in compliance with regulatory requirements. The role emphasizes timely processing of clinical information to prevent delays and denials, while maintaining confidentiality.

The position serves as a liaison among physicians, patients, case management, and Patient Registration,

Qualifications

• Two to three years of clerical experience in a health care field.
• High school diploma or equivalency required; Associates degree preferred.
• Experience with insurance verification and authorization processes is a plus.

Responsibilities

• Enter and retrieve information from automated systems and prepare reports.
• Verify Medicare and regulatory timelines as applicable.
• Collect demographic and insurance data and enter into systems accurately.
• Prepare and review documents in accordance with procedures and timelines.
• Contact to obtain missing information for incomplete forms.
• Inform patients and staff of issues with authorizations and resubmit as needed.
• Coordinate with insurance providers to confirm benefit levels for inpatient stays.
• Respond to inquiries and provide information; act as liaison between physicians, patients, and registration.
• Follow up with patients, physicians, and departments to ensure delivery of services.

Skills

Clerical experience

Healthcare workflow

Education

High school diploma

Associates degree preferred

Tools

Automated data systems

Job description

Job Summary

The Authorization Specialist is responsible for performing complex clerical procedures related to verifying insurance information and obtaining authorization for inpatient admissions and specialized clinical procedures and treatments in accordance with established rules, procedures, specified time frames, and regulatory requirements. The specialist processes clinical information in a timely manner to prevent treatment delays and to avoid denials from third-party payers and maintains confidentiality of patient information.

Responsibilities

• Enters and retrieves information from various automated systems and prepares specialized reports.
• Ensure completion of Medicare Physician Certification according to the regulatory timeline.
• Collects demographic and insurance data and enters accurately into specialized automated systems.
• Prepares, reviews for completion, and maintains required documents in accordance with established procedures, time frames and regulatory requirements.
• Makes contact to obtain missing information for incomplete forms.
• Advises patients and clinical staff of problems with insurance authorizations and resubmits requests with additional or revised information.
• Contact insurance providers to confirm the level of benefits for inpatient admissions.
• Responds to customer inquiries and provides information.
• Serves as liaison between the physician's offices, patients, case management department and Patient Registration.
• Follows up with patients, physicians, clinical and ancillary departments to ensure optimum delivery of services.
• Communicates with case managers, hospital personnel, and external agencies to provide information or resolve discrepancies.
• Other duties as assigned.

Qualifications/Requirements

Experience: Two to three years of clerical experience in a health care field or related area required.

Education: A high school diploma or equivalency required, Associates Degree Preferred

Licenses / Certifications: N/A