Authorization Specialist — Drive Patient Care Approvals

TidalHealth; Maryland; Hybrid; USD 52,000 - 76,000; Full time

Benefits offered by this job

Health insurance

403(b) matching

Tuition assistance

Generous PTO and Holidays

Onsite Child Care

Pet Insurance

Employer-paid Short-Term Disability

Long-Term Disability

Job summary

The Authorization Specialist at TidalHealth Atlantic in Berlin, MD monitors and submits insurance authorizations across prior service, surgical, acute hospital, and post-acute care needs to align with medical necessity policies.

Collaborating with Case Managers, Utilization RNs, physicians, insurers, and discharge planners, this role also handles non-clinical tasks like invoicing, pre-authorizations, and benefit verification to streamline patient care.

Qualifications

• Bachelor’s degree in health-related field or equivalent medical office experience required.
• Minimum of three (3) years clinical/medical office and/or related experience required.
• Working knowledge of ICD Diagnostic Codes and medical terminology.

Responsibilities

• Monitor and submit all insurance authorizations including prior service, surgical, acute hospital, and post-acute care authorizations.
• Collaborate with Case Managers, Utilization RNs, physicians, insurance companies, finance, patients, providers, and authorization process stakeholders to reduce length of stay and ensure appropriate use of benefits.
• Maintain and follow up on non-clinical administrative tasks related to utilization review, discharge planning, PCP appointments, regulatory paperwork, invoicing, prior authorizations, and benefit verification.
• Track and document appeal/denial activity and case documentation.

Skills

Microsoft Excel

Microsoft Outlook

Microsoft Word

ICD codes

Education

Bachelor's degree in health-related field

Job description

The Authorization Specialist at TidalHealth Atlantic in Berlin, MD monitors and submits insurance authorizations across prior service, surgical, acute hospital, and post-acute care needs to align with medical necessity policies.

Collaborating with Case Managers, Utilization RNs, physicians, insurers, and discharge planners, this role also handles non-clinical tasks like invoicing, pre-authorizations, and benefit verification to streamline patient care.