Authorization Specialist I

Warren Clinic, Inc.; Tulsa (OK); On-site; USD 36,000 - 52,000; Full time

Job summary

Warren Clinic, Inc. in Tulsa, OK is seeking an Authorization Specialist I to support billing and the revenue cycle by securing prior authorizations and benefit verifications for scheduled visits and inpatient admissions.

This role emphasizes accuracy, independence, and timely processing to aid patient access and reduce denials. The position requires 1-2 years of relevant experience, strong communication skills, and the ability to navigate payer systems while maintaining confidentiality.

Qualifications

• High School Diploma or GED.
• 1-2 years relevant experience.
• 1 year of benefits verification or authorization experience or 2 years of pre-registration experience.
• Post-secondary education may be substituted for 1 year of experience.
• Basic knowledge of medical billing and insurance follow-up activity.
• Ability to navigate insurance websites to access patient eligibility and payment information.
• Good written and verbal communication skills.

Responsibilities

• Monitors queues to determine encounters requiring pre-registration, verification, authorization, or corrections.
• Meets daily and weekly productivity goals.
• Evaluates referral/authorization requirements and ensures they are met prior to procedures.
• Reviews CPT/diagnosis code information to support authorization per payer guidelines.
• Processes authorizations within required timelines and documents actions.
• Coordinates with other departments and staff for special needs.
• Counsels patients to obtain additional information when required by payer.
• Maintains patient privacy and HIPAA compliance.

Skills

Healthcare terminology

Insurance terminology

Computer skills

Office equipment

Phone-based support

Communication skills

Time management

Billing knowledge

Education

High school diploma or GED

Job description

Full Time Job Summary

The Authorization Specialist I directly impacts the billing and collections functions of the revenue cycle by ensuring accuracy of insurance information and procuring prior authorization and predetermination for scheduled patient appointments as well as inpatient admissions. Timely facilitation of insurance approval contributes to the accuracy of patient estimates and pre-service collections, patient ease of access to care and serves to prevent denials of claims submitted for payment. Authorization Specialists do not have leadership responsibilities, but are expected to perform duties with a high degree of independence, meeting productivity and quality metrics consistently.

Minimum Education

• High School Diploma or GED.

Licensure, Registration and/or Certification

• None.

Work Experience

• 1 - 2 years relevant experience.
• 1 year of benefits verification or authorization experience or 2 years of pre-registration experience.
• Post-secondary education may be substituted for 1 year of experience.

Knowledge, Skills and Abilities

• Basic healthcare and insurance terminology.
• Basic computer knowledge and skills.
• Proficient with office machines, including fax, copier and scanner.
• Ability to navigate insurance websites to access patient, eligibility and payment information.
• Good communication skills - written and verbal.
• Phone-based contact center skills involving multiple-line phone systems.
• Employee must possess the ability to organize and prioritize work; must be detail oriented.
• Understanding of a professional business environment.
• Basic knowledge of medical billing and insurance follow-up activity.

Essential Functions and Responsibilities

Monitors patient and/or referrals and/or denials work queues to determine encounters that require pre-registration, verification, authorization, or corrections to ensure proper billing. Works encounters according to assignment and consistently meets daily and weekly productivity goals. Evaluates physician referral and authorization requirements and takes appropriate steps to ensure requirements are met prior to date of procedure. Reviews clinical documentation for CPT/diagnosis code information to support authorization/precertification according to payer guidelines. Accurately monitors, reviews and processes authorizations and validates the requests are accurate, within the required timeline, and in compliance with the applicable insurance guidelines. Coordinates as needed with other departments/ancillary areas for special needs or resources. Counsels clinical partners and/or patients to facilitate additional information when required by payer. Coordinates with patient, referring physician's office and/or referring location, scheduled service area, financial counselors, case manager, and others as appropriate to obtain additional information or provide information on patients' financial status. Documents pertinent information and efforts in computer system based upon department documentation standards. Protects the privacy and security of patient health information to ensure that confidentiality is maintained.

Decision Making

Independent judgment in planning sequence of operations and making minor decisions in a complex technical or professional field.

Working Relationship

Works directly with patients and/or customers. Works with internal and/or external customers via telephone or face to face interaction. Works with other healthcare professionals and staff.

Special Job Dimensions

None.

Supplemental Information

This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.

Orthopedics - TBJ Admin - Warren Clinic Location: Tulsa, Oklahoma 74146 EOE Protected Veterans/Disability

Saint Francis is a Catholic, not-for-profit Health system based in Tulsa, Oklahoma. We are the largest private employer in Eastern Oklahoma with over 12,000 employees, including 1,000 physicians. The health system is anchored by the 1,112-bed Saint Francis Hospital, the largest hospital in Oklahoma and the 11th largest in the nation. Our system also includes hospitals in south Tulsa, Muskogee and Vinita, as well as 110 Warren Clinic locations from Monkey Island to McAlester, northeastern Oklahoma's only children's hospital, a level IV neonatal intensive care unit, a 168-bed heart hospital, and Tulsa's leading trauma and emergency center.