Care Authorization Specialist — Payer Liaison

Hemet Global Medical Center; Santa Ana, Northern (CA, KY); Hybrid; USD 30,000 - 51,000; Full time

Job summary

Hemet Global Medical Center in Santa Ana, CA is seeking an Authorization Specialist to ensure timely verification and validation of authorizations for Commercial and Managed care inpatients and other services.

The role involves contacting insurance companies, reviewing discharge authorizations, obtaining missing authorizations within required timeframes, and maintaining accurate documentation and reporting.

Qualifications

• High school diploma or equivalent or combination of experience and education.
• Minimum of two (2) years of experience in scheduling, authorization and referrals in a health care setting.
• Strong attention to detail.
• Excellent communications skills both oral and written.
• Excellent follow up and follow through skills.

Responsibilities

• Verify and validate authorizations for Commercial and Managed care inpatients and other services.
• Contact insurance companies by phone or website to secure authorization.
• Review discharged managed care patients for authorization entry in the system.
• Obtain missing authorizations within 3 business days of discharge or within 7 days of admission.
• Check bill hold weekly for pending authorizations.
• Assist with sending delinquent reviews and resending reviews not received by Payors.
• Maintain professional relationships with Case Management and departments impacting authorizations.
• Analyze authorization issues by payer and report monthly to leadership.
• Document all authorizations in the hospital system per required format.

Skills

Attention to detail

Excellent communication

Follow up

Education

High school diploma or equivalent

Job description

Hemet Global Medical Center in Santa Ana, CA is seeking an Authorization Specialist to ensure timely verification and validation of authorizations for Commercial and Managed care inpatients and other services.

The role involves contacting insurance companies, reviewing discharge authorizations, obtaining missing authorizations within required timeframes, and maintaining accurate documentation and reporting.