Authorization Specialist I

100 Albany Med Health System; United States; On-site; USD 50,000 - 70,000; Full time

Benefits offered by this job

Health insurance

Wellbeing programs

Job summary

Albany Med Health System is seeking an Authorization Specialist I to secure referrals and authorizations for ambulatory, ancillary, surgical and/or procedural services. The role requires interacting with patients and stakeholders to ensure financial clearance and adherence to payer guidelines.

The AS I will use eligibility tools to verify insurance, interpret benefits, and capture relevant information for service provision, aiming to minimize delays and ensure proper pre-service financial

Qualifications

• Experience with insurance payer authorizations and verifications.
• Ability to interact with patients and providers in a high-volume setting.
• Understanding of referring/authorization guidelines and scheduling impacts.

Responsibilities

• Determine authorization needs for hospital services (inpatient, outpatient, clinic).
• Obtain insurance information and verify active coverage; secure authorizations via portal, fax or phone.
• Explain financial obligations to patients and discuss eligibility and benefits.

Skills

Insurance verification

Eligibility interpretation

Financial clearance

Patient communication

HIPAA awareness

Tools

Authorization portals

Electronic Health Records

Job description

Department/Unit: Patient Access

Work Shift: Day (United States of America)

Salary Range: $49,763.00 - $69,668.00

The Authorization Specialist I (AS I)

The AS I is responsible for financially securing Ambulatory, Ancillary, Surgical and Procedural services. This includes securing Referral and Authorization. Insurance Verification and Benefit interpretation to discern insurance guidelines are being adhered to. Ability to interact with patients and stakeholders for the successful financial clearance will be critical to be successful in the compliance of authorization and referral guidelines. Position requires ability to work in a high-volume, fast-paced environment. Understanding complex scheduling needs of our patients in an empathetic, compassionate manner is critical. Position is required to use eligibility application and authorization portals to invoke request to verify insurance eligibility, interpret response and capture appropriate health insurance information as it pertain to the service being rendered. The position requires ability to understand and apply contractual benefits to the service being rendered, with ability to collect patient financial obligation pre-services.

The Authorization Specialist I has ability to elevate to AS II per Career Ladder Guidelines.

1. Responsible for financial clearance of scheduled services for Hospital Surgical (Inpatient and Outpatient) and Clinic appointments, assuring no delay in payment of claim.
2. Ability to identify authorization needs including but not limited to Out of Network management of appointments and encounters.
3. Responsible to interpret information received from Insurance Payer regarding patient's eligibility and financial responsibility.
4. Responsible to discuss financial obligation to patient, if required.
5. Ability to accurately interpret referral/physician order to meet the patient and/or provider need for scheduling of services correctly including multi-scheduling needs for related services.
6. Responsible for scanning or managing online form template to maintain the Electronic Health Record.
7. Comprehend Federal, State, Third Party Payer regulations as it pertains to a hospital and practice pre-registration.
8. Excellent knowledge of third- party payer authorization portals; authorization guidelines by payer and critical detail to follow up.
9. Responsible for review of services being rendered to ensure the appropriate setting of care has been assigned by the physician's office.
10. Obtains all insurance information from patient and verifies insurance to ensure active coverage for services being scheduling and obtains authorization via portal, fax and telephone.
11. Provides thorough comments, where applicable for all conversations with patients or providers.
12. Ability to organize work with multiple steps to ensure no scheduling or authorization needs are missed.

Thank you for your interest in Albany Med Health System!

Albany Med Health System is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Med Health System, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that: Access to information is based on a "need to know" and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Health System policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.

Albany Medical Center is the centerpiece of medicine, research, and medical education in New York's Capital Region and is the area's largest private employer with more than 10,000 employees. Albany Medical Center offers excellent career opportunities in a wide range of roles in both patient care and administration.

We value all our staff members and offer outstanding employee benefits including:

• Excellent health care coverage with no copay at Albany Medical Center providers
• A wide array of services and programs to support emotional, physical, and mental wellbeing

Anchored in the state's historic capital city, Albany Medical Center offers a full range of inpatient and outpatient care and is home to the region's largest hospital, only Level 1 adult and pediatric trauma centers, and only children's hospital. The downtown campus also offers opportunities at Albany Medical College.

Albany Medical Center, along with Columbia Memorial Health, Glens Falls Hospital, Saratoga Hospital, and the Visiting Nurses, form the Albany Med Health System, serving more than three million people over 25 counties.