Authorization Specialist | FT | Weekdays | Neurology Clinic | Memphis

Methodist Le Bonheur Healthcare; Memphis (TN); Hybrid; USD 38,000 - 58,000; Full time

Job summary

Methodist Le Bonheur Healthcare in Memphis seeks a precertification specialist to manage authorizations for inpatient, diagnostic, and outpatient services based on plans and medical necessity.

The role requires knowledge of CPT/HCPCS/ICD-10 codes, strong attention to detail and communication skills, and experience with insurance authorizations and a healthcare information system. A Tennessee LPN license is preferred.

Qualifications

• High School Diploma or Equivalent required.
• Medical insurance authorizations and/or clinical experience 1–3 years required.
• Licensed Practical Nurse (TN) preferred.

Responsibilities

• Precertification of eligible medical services and procedures for inpatient, diagnostic, and outpatient services.
• Coordinate documentation required for precertification.
• Establish good working relationships with physicians, office staff, patients, and healthcare team.

Skills

Attention to detail

Analytical ability

Verbal & written communication

Microsoft Word

Healthcare information systems

PPO/Managed care experience

Education

High School Diploma or Equivalent

Tools

Microsoft Word

Healthcare information system

Job description

If you are looking to make an impact on a meaningful scale, come join us as we embrace the Power of One! We strive to be an employer of choice and establish a reputation for being a talent rich organization where Associates can grow their career caring for others. For over a century, we’ve served the health care needs of the people of Memphis and the Mid-South. Responsible for precertification of eligible medical services and procedures for inpatient, diagnostic, and outpatient services. Ensures complete documentation is obtained that meets insurer guidelines for medical necessity and payment for services. Models appropriate behavior as exemplified in MLH Mission, Vision and Values. Working at MLH means carrying the mission forward of caring for our community and impacting the lives of patients in every way through compassion, a deliberate focus on service expectations and a consistent thriving for excellence.

A Brief Overview Responsible for precertification of eligible medical services and procedures for inpatient, diagnostic, and outpatient services. Ensures complete documentation is obtained that meets insurer guidelines for medical necessity and payment for services. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

What you will do Responsible for precertification of eligible medical services and procedures for inpatient, diagnostic, and outpatient services based on medical plan documents and medical necessity. Manages pre-certifications for more complex surgical and invasive procedures that require strong clinical knowledge. Coordinates all documentation required for precertification of services. Establishes a good working relationship with physicians, physician office staff, patients, and other members of the healthcare team.

Education/Formal Training Requirements Required - High School Diploma or Equivalent

Work Experience Requirements Required - Medical insurance authorizations and/or clinical experience 1-3 years

Licenses and Certifications Requirements Preferred - Licensed Practical Nurse - Tennessee - Tennessee Board of Nursing

Knowledge, Skills and Abilities Knowledge and experience in coverage practices, terminology, and requirements for referrals and authorization/pre-certification used by third party payers, Medicare, and secondary payer rules. Knowledge of CPT, HCPCS, and ICD-10 codes preferred. Demonstrated analytical ability to collect and interpret insurance and contract information. Experience dealing with PPO and Managed Care insurance. Strong attention to detail and critical thinking skills. Experience with a computerized healthcare information system required. Familiarity with fundamental Microsoft Word software. Excellent verbal and written communication skills.

Supervision Provided by this Position There are no lead or supervisory responsibilities assigned to this position.

Physical Demands The physical activities of this position may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion. Must have good balance and coordination. The physical requirements of this position are: light work - exerting up to 25 lbs. of force occasionally and/or up to 10 lbs. of force frequently. The Associate is required to have close visual acuity to perform an activity, such as preparing and analyzing data and figures; transcribing; viewing a computer terminal; or extensive reading. The conditions to which the Associate will be subject in this position: The Associate is not substantially exposed to adverse environmental conditions; job functions are typically performed under conditions such as those found in general office or administrative.

The Associates are passionate about what they do, the service they provide and the patients they serve. We value family, team and a Power of One culture that requires commitment to the highest standards of care and unity.

Boasting one of the South's largest medical centers, Memphis blends a friendly community, a thriving and growing downtown, and a low cost of living.

We see each day as a new opportunity to make a difference in the lives of the people in our community.

Within any role at Methodist Le Bonheur, you can play a rewarding and fulfilling part in helping us provide high-quality, innovative and compassionate care to the people of Memphis and the Mid-South.

Our goal is to improve every life we touch, including our Associates. For over a century, we’ve served the health care needs of the people of Memphis and the Mid-South, and we value the dedicated individuals who play such a crucial role in helping us fulfill our mission.

With Methodist Le Bonheur, you’ll be recognized and rewarded, treated with respect and given many opportunities to learn, grow and build a fulfilling career.

Because we’re not at our best until you are at yours.