Authorization Specialist II

Saint Francis Hospital, Inc.; Oklahoma; Hybrid; USD 42,000 - 54,000; Full time

Job summary

The Authorization Specialist II at Saint Francis Hospital, Inc. ensures accuracy of insurance information and secures prior authorizations for non-oncology, oncology, and radiation oncology infusions. The role handles NCCN guidelines and medical necessity reviews, coordinating with physicians and pharmacy staff.

You will maintain patient confidentiality, manage complex queues, and support timely billing while delivering excellent service within our Oklahoma health system.

Qualifications

• Basic healthcare knowledge and insurance terminology including medical billing and insurance follow-up processes.
• PC and basic software skills.
• Proven keyboard skills with the ability to type 75 WPM.
• Excellent oral and verbal communication skills.
• Ability to navigate insurance websites to access patient eligibility and payment information.
• Ability to organize and prioritize work and the ability to be detail oriented.
• Ability to interact with physicians, physician offices and all levels of team members within the health system.

Responsibilities

• Monitors patient referrals and denials queues to determine encounters requiring pre-registration, verification, authorization, or corrections.
• Reviews physician orders for medical necessity and notes treatment frequency/duration for revisions as needed.
• Reviews CPT and diagnosis codes to support authorization according to payer guidelines.
• Processes authorizations and validates requests are within timelines and compliant with insurance guidelines.
• Coordinates with pharmacy and clinical staff to identify codes for authorization submission and NCCN alignment.
• Communicates with patients, physician offices, and financial counselors to obtain additional information.
• Documents information in the system per department standards and protects patient privacy.

Skills

Benefits verification

Authorization experience

Medical terminology

Typing 75 WPM

Communication skills

Insurance portals

Education

High School Diploma or GED

Tools

EHR systems

Basic PC software

Job description

Schedule

Full Time Days *Must live in commuting distance to Tulsa, OK* Schedule- Monday-Friday 8:30am-5:00pm; following the completing of training 3-months of onsite training required

Job Summary

The Authorization Specialist II ensures accuracy of insurance information and obtains prior authorization and predetermination requirements for non-oncology infusions, oncology infusions, and radiation oncology. This role navigates highly detailed processes including treatment plans, National Comprehensive Cancer Network (NCCN) guidelines, medical necessity reviews, authorization submissions and follow-up care. The Authorization Specialist II maintains exceptional customer service, promotes the teamwork, and reflects the goals, values, and mission of the health system.

Minimum Education

High School Diploma or GED.

Licensure, Registration and/or Certification

None.

Work Experience

Minimum 2 years of benefits verification or authorization experience or 3 years of pre-registration experience. Post -secondary education may be substituted for 2 years of experience.

Knowledge, Skills and Abilities

Basic healthcare knowledge and insurance terminology including medical billing and insurance follow-up processes. PC and basic software skills. Proven keyboard skills with the ability to type 75 WPM. Excellent oral and verbal communication skills. Ability to navigate insurance websites to access patient eligibility and payment information. Ability to organize and prioritize work and the ability to be detail oriented. Ability to interact with physicians, physician offices and all levels of team members within the health system.

Essential Functions and Responsibilities

Monitors patient, referrals, and 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 orders and pre-screens for medical necessity; notes frequency and duration of treatment plan and communicates directly with ordering provider or clinical staff to facilitate order revisions as indicated. Reviews clinical documentation for Current Procedural Terminology (CPT) and diagnosis code information to support authorization and precertification according to payer guidelines. Monitors, reviews, and processes authorizations and validates the requests are accurate, within the required timeline, and in compliance with the applicable insurance guidelines. Consults with pharmacy team members regarding provider ordered drugs in relation to payer preference to identify appropriate codes for authorization submission and to establish the appropriateness of the treatment regimen in alignment with NCCN and payer guidelines. Confers with pharmacy or clinical partners to facilitate additional information when required by payer. Coordinates with patient, referring physician's office, referring location, scheduled service area, financial counselors, case manager, and others, as appropriate to obtain additional information or provide information on patient 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 judgement in planning sequence of operations and making minor decisions in a complex technical or professional field.

Working Relationships

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.

Pre-Arrival - Yale Campus Location

Virtual Office, Oklahoma 73105

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.