Care Coordination & Authorization Specialist

Undisclosed; North Platte (NE); On-site; USD 40,000 - 56,000; Full time

Job summary

Great Plains Health is hiring an Authorization Specialist to coordinate patient care across the health system. The role supports plan-of-care development, resource utilization, and communication with physicians, schedulers, and the patient financial services team.

The position focuses on ensuring medical necessity and coordinating with payers to comply with utilization and regulatory requirements. Strong terminology knowledge and CPT/ICD coding are essential for success.

Qualifications

• High School Diploma or Equivalent.
• Degree in Secretarial Administration, Health Care Administration, Business, and/or Accounting preferred.
• Knowledge of Medical Terminology, CPT and IDC codes required.

Responsibilities

• Manages individual patients across the health care continuum to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
• Acts in a leadership function with process improvement activities for populations of patients to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
• Effectively communicates the plan across the continuum of care.
• Evaluates the medical necessity and appropriateness of care, optimizing patient outcomes.
• Establishes and promotes a collaborative relationship with physicians, payers, and other members of the health care team. Collects and communicates pertinent, timely information to payers and others to fulfill utilization and regulatory requirements. Works on denials to overthrow them.
• Educates internal members of the health care team on pre-authorizations and managed care concepts. Serve as an informational and educational resource to outside facilities i.e. nursing homes, assisted living and rehabilitation centers. Facilitates integration of concepts into daily practice.
• Acts in an educational function to help identify, collects and communicates pertinent, timely information to fulfill utilization and regulatory requirements.

Skills

Medical terminology

CPT/ICD coding

Communication

Education

High School Diploma or Equivalent

Secretarial Administration/Health Care Admin/Business/Accounting degree preferred

Job description

Great Plains Health is hiring an Authorization Specialist to coordinate patient care across the health system. The role supports plan-of-care development, resource utilization, and communication with physicians, schedulers, and the patient financial services team.

The position focuses on ensuring medical necessity and coordinating with payers to comply with utilization and regulatory requirements. Strong terminology knowledge and CPT/ICD coding are essential for success.