Authorization Specialist

GPH - North Platte NE Hospital Corp DBA Great Plains Health; United States; On-site; USD 40,000 - 65,000; Full time

Job summary

Great Plains Health in North Platte, NE seeks an Authorization Specialist to join the Financial Counseling team. You will coordinate care across the health care continuum, evaluate medical necessity, and assist with pre-authorizations and payer communications to support patient care and billing accuracy.

The role requires understanding of medical terminology and payer requirements, with a focus on effective collaboration with physicians, nurses, schedulers and patient financial services to

Qualifications

• Education: HS Diploma or equivalent; related degrees preferred.
• Knowledge of Medical Terminology, CPT and ICD codes required.
• Credentials: None.

Responsibilities

• Coordinate and manage care across the health care continuum.
• Evaluate medical necessity and appropriateness of care.
• Communicate plan across the continuum of care to payers and team.
• Assist with pre-authorizations and managed care concepts.
• Work on denials to overturn them.

Skills

Medical terminology

Denials management

Communication

Education

High School Diploma or equivalent

Tools

CPT and ICD codes

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

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

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 overturn 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.

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. We are rooted in passion. We pursue excellence, innovation and world-class quality every day. Here, you'll find a team that works together in the interest of unmatched patient care. You'll find positive attitudes, advanced technology and a collegial culture. You'll find an appreciation for the healthcare roles and a commitment to professional growth. Here, you’ll find purpose and connection in an independent hospital driven to inspire health and healing by putting our patients first—always.