Authorization Specialist - Bend, Oregon

shm; Bend (OR); Presencial; USD 25 000 - 39 000; Tempo integral

Resumo da oferta

VillageMD is seeking an Authorization Specialist in Bend, Oregon to manage surgical, diagnostic and referral authorizations as part of revenue cycle operations. You will verify insurance requirements and ensure timely processing while maintaining patient confidentiality.

Responsibilities include communicating with patients, physicians and staff to resolve issues, updating authorizations in the system, and collaborating with reimbursement teams to minimize denials and streamline workflows.

Qualificações

• High School Diploma or GED required.
• Vocational/Technical training preferred.
• 2-4 years of related experience preferred.
• Experience with standard office equipment; MS Office Suite and Windows-based environments required.
• Experience with Epic software.

Responsabilidades

• Obtain authorizations for surgical procedures, diagnostics and referrals.
• Verify insurance coverage and clinical policy requirements.
• Complete referrals and prior authorizations in a timely manner.
• Communicate with patients and providers to resolve authorization issues.
• Maintain patient confidentiality and accurate data in the system.

Conhecimentos

Epic software

Communication

Formação académica

High School Diploma or GED

Vocational/Technical Training

Ferramentas

Microsoft Office Suite

Windows OS

Descrição da oferta de emprego

About Our Company

We're a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care.

Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through VillageMD and our operating companies Village Medical , Village Medical at Home , Summit Health , CityMD , and Starling Physicians .

When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care.

Please Note: We will only contact candidates regarding your applications from one of the following domains: @summithealth.com, @citymd.net, @villagemd.com, @villagemedical.com, @westmedgroup.com, @starlingphysicians.com, or @bmctotalcare.com.

Job Description

The Authorization Specialist is responsible for obtaining authorizations for surgical procedures, diagnostic testing, medications, DME, outgoing referrals, and other services as part of the daily operations of the Revenue Cycle Department. Authorization Specialists must have a keen understanding of medical insurance and the clinical policies that determine the authorization protocols for each health plan.

Essential Job functions:

• Identify all appointments and procedures for assigned departments that require authorization by monitoring the schedules, system reports, and dashboards
• Identifies the referral and authorization requirements of the patients' insurance plans by using various on-line resources according to department workflows
• Demonstrates knowledge of insurance carrier guidelines, clinical policies, and state guidelines pertaining to referrals and prior authorization
• Verifies insurance eligibility and benefits, and updates the patient's insurance information as necessary
• Completes referrals and prior authorizations in a timely manner according to department guidelines and workflows
• Communicates clearly and effectively with patients, physicians, office staff and manager to resolve issues that may result in a denied or delayed authorization request.
• Demonstrates complete system knowledge, ability to run reports, document and manage referrals and authorizations, move correspondence, resolve eligibility and authorization holds, and other system tasks within the user's security access
• Demonstrates the ability to request, prepare, and recognize the documentation required to support the medical necessity for the service being authorized
• Provides the supervisor and manager with immediate feedback on issues affecting workflow, reimbursement, and customer service.
• Ensures that appropriate and accurate information is entered in the patient account
• Responds timely and collaborates effectively with the Reimbursement Department teams to limit denials and ensure proper reimbursement
• Collaborate with team members to meet department deadlines and benchmarks
• Demonstrates the ability to use the electronic tools and systems available to organize and process the daily work
• Anticipates and performs necessary duties.
• Maintains patient confidentiality
• Make inbound and outbound phone calls daily.

General Job functions:

• Expert in selecting the correct insurance package in Epic.
• Updates authorizations and claims to reflect the new insurance package.
• Expert in sorting work queues and reports to identify and process the daily work (Manage Schedules - Inbound Referral Report - Outgoing Referrals)
• Moves correspondence from the dashboard to the patient's account.
• Experts generally accepted insurance benefit terms and processes.
• Expert in Communication (Case and authorization notation - Physician and Practice location staff - Peers - Supervisor/Manager - Payers)
• Expert in requesting and preparation of supporting documentation such as medical records, dictation, and orders.
• Expert in investigation of authorization denials and appeals (Insurance - Patient)

Environmental Risks:

• Allergens: dust, mold and/or pollen
• Combative Patients / Visitors

Education, Certification, Computer and Training Requirements:

• High School Graduate/GED Required.
• Vocational / Technical School / Diploma Program Preferred
• 2-4 years of related experience Preferred
• Experience with Standard Office Equipment (Phone, Fax, Copy Machine, Scanner, Email/Voice Mail) Preferred.
• Experience Standard Office Technology in a Window based environment & Microsoft Office Suite Required.

Physical Job Requirements:

• Physical agility, which includes ability to maneuver body while in place.
• Dexterity of hands and fingers.
• Endurance (e.g. continuous typing, prolonged standing/bending, walking).

Travel:

• Travel to satellite locations for meetings

About Our Commitment

Total Rewards at VillageMD

Our team members are essential