Authorization Specialist Orthopedics & Spine

Trinity Health Mid-Atlantic; United States; On-site; USD 28,000 - 34,000; Full time

Job summary

Trinity Health Mid-Atlantic is seeking an Authorization Specialist to review, analyze, and code medical information for referrals and procedures. You will work with clinical staff to verify insurance updates and monitor expirations to support authorization and denial workflows.

Qualified candidates will have CCS/AR/RA credentials or an LPN and experience with ICD-9-CM, CPT and E/M conventions. Confidentiality and strong communication are essential to succeed in this role.

Qualifications

• Certification or eligibility in coding/records management.
• Experience with referrals, denials, and authorization processes preferred.
• Familiarity with ICD-9-CM, CPT & E/M coding conventions.

Responsibilities

• Review, analyzes, and interprets medical information for classification and abstracting.
• Monitor referrals expirations and verify insurance before procedures.
• Collaborate with medical staff and clinical services on authorization/denial workflows.
• Support ongoing education and maintain knowledge of relevant areas.

Skills

Excellent communication

Interpersonal skills

Customer service oriented

Confidentiality

Education

Certified Coding Specialist

Accredited Record Technician

Registered Record Administrator

Licensed Practical Nurse (LPN)

Tools

PC/CRT skills

Job description

Employment Type: Full time Shift: Description: Authorization Specialist Job Description Mission Statement: We, St Joseph’s Health and Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities. Vision: To be world-renowned for passionate patient care and outstanding clinical outcomes. Core Values: In the spirit of good Stewardship, we heal by practicing Justice in fostering right relationships to promote common good, Reverence in honoring the dignity of every person, Excellence in expecting the best of ourselves and others; Integrity in being faithful to who we say we are.

POSITION SUMMARY: Reviews, analyzes, and interprets complex medical information, applying specific knowledge of coding requirements and conventions to correctly classify, code and abstract health information. Works collaboratively with the medical staff and other clinical services staff. This role focuses on monitoring expirations of referrals, verifying insurance updates prior to procedure, and supporting authorization and denial processes.

EDUCATION, TRAINING, EXPERIENCE, CERTIFICATION AND LICENSURE: Certified Coding Specialist, Accredited Record Technician (or eligible), Registered Record Administrator (or eligible) or Licensed Practical Nurse (LPN) with a minimum of 5 years’ experience in an appropriate health care setting. Ideally, has a background in referrals, denials, and/or authorization processes. Working knowledge of ICD-9-CM, CPT & E & M coding conventions as applicable. Participates in orientation and continuing education. Updates and maintains knowledge and skills related to specific areas of expertise.

SPECIAL EQUIPMENT, SKILLS OR OTHER REQUIREMENTS: Knowledge of office equipment, PC/CRT skills. Close visual/concentration efforts required (due to potential to review records continuously). Excellent communication skills, both oral and written, as well as good interpersonal skills required. Ability to work with confidential material in a responsible manner. Customer service orientated. Strong communication skills with both colleagues and patients.

WORK ENVIRONMENT AND HAZARDS: Exposure Class II – No exposure to blood, body fluids, excretions or secretions. Office setting.

PHYSICAL DEMANDS: Light work: sitting, standing, walking, lifting, pulling, pushing, and carrying. Depending on specific performance criteria exposure to a CRT and repetitive motions (data entry).

WORK CONTACT GROUP: All services, medical staff, employees, limited contact with patients and visitors, and various regulatory and professional agency staff on a limited basis.

SUPERVISED BY: Manager and Department Coordinator SUPERVISES: None CAREER PATH: Coordinator/Manager Original: July 1997 Revised: October 2009 Revised: August 2011

General Performance Criteria: Coding Specialist Expectations Exceeds Meet Below Reviews the record for information regarding diagnoses and procedures performed. Uses established coding/classification systems to accurately Code diagnoses, procedures and evaluation and management, in compliance with hospital policy/procedures and industry standards. Abstracting/Data entry. Works closely with referrals, authorizations, and denial teams. Interacts with medical and clinical services staff in a positive and professional manner. Educates staff as needed. Completes state-specific registry abstracts as required. Meets established quality/productivity standards. Maintains certification/credentialing. Adheres to established hospital policy and procedure related to job functions. Maintains confidentiality related to patients, staff, and visitors.

Pay Range based on location and experience. :$19.50-$25.15

Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. Together, we’re 121,000 colleagues and nearly 36,500 physicians and clinicians caring for diverse communities across 27 states. Nationally recognized for care and experience, our system includes 101 hospitals, 126 continuing care locations, the second largest PACE program in the country, 136 urgent care locations, and many other health and well-being services. Based in Livonia, Michigan, in fiscal year 2023, we invested $1.5 billion in our communities through charity care and other community benefit programs. For more information, visit http://www.trinity-health.org. You can also follow Trinity Health on LinkedIn.