Authorization Specialist I - CMH

100 Albany Med Health System; Penn Hills (Allegheny County); 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 a Patient Engagement Authorization Specialist I (IAS II) to secure financial clearance for ambulatory, ancillary, surgical and procedural services. The role involves securing referrals and authorizations, verifying insurance eligibility, and interpreting benefits to ensure compliance with guidelines.

The position requires interacting with patients and stakeholders in a high-volume, fast-paced environment and using eligibility portals to verify information and

Qualifications

• Associates degree required; bachelor's preferred.
• 3-5 years in hospital, physician office, or call center.
• Strong insurance knowledge related to complex scheduling and authorization.

Responsibilities

• Secure payment responsibility for Ambulatory, Ancillary, Surgical and Procedural services including referrals and authorizations.
• Interact with patients and stakeholders to ensure financial clearance in a high-volume setting.
• Use eligibility and authorization portals to verify insurance eligibility, interpret responses and capture required health insurance information.
• Understand and apply contractual benefits to services and collect patient financial obligation pre-services.
• Maintain accuracy and compliance with HIPAA and system guidelines.

Skills

Customer service

Attention to detail

Multi-tasking

Empathy

Education

Associates Degree

Bachelor Degree preferred

Tools

Eligibility portals

Insurance verification systems

Job description

Department/Unit: Patient Access Work Shift: Day (United States of America) Salary Range: $49,763.00 - $69,668.00 Salary Range: $18.00 - $28.76 The Patient Engagement Authorization Specialist I (IAS II) The IAS II 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 of 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 pertains 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.

Education

Associates Degree; Bachelor Degree preferred

Licensure, Certification & Registration

CHAA (or acquired within 2 years of hire)

Experience

Winning customer service personality with ability to engage patients, provider and provider staff as well as insurance company representatives via telephone with superior patient experience. 3-5 years' experience in Hospital or Physician office experience or call center environment, preferred Strong insurance knowledge specific to complex scheduling needs and authorization management.

Skills, Knowledge & Abilities

Proven customer service skill with ability to exceed expectations Demonstrated knowledge payer authorization requirements Strong attention to detail Ability to multi-task in stressful and high patient volume unit Must be able to manage pressure of very tight timeframes to execute task Ability to learn in classroom, utilizing resources Ability to remain composure under pressure Ability to train and onboard colleague Ability to review information and draw appropriate conclusion Good judgement and ability to be resourceful to problem solve; escape issues as needed Team minded worth ethic Demonstrated ability interpret patient's insurance benefits and apply the applicable contractual obligations Critical thinking ability regarding issues with financially securing payment.

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.

Employee Benefits

• 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.