Care Coordination & Authorization Specialist

gphealth; North Platte (NE); On-site; USD 42,000 - 62,000; Full time

Job summary

Great Plains Health in North Platte, Nebraska is seeking an Authorization Specialist to coordinate patient care across the continuum. You will assess care plans, determine resource utilization, and document progress to meet health care needs.

You will work closely with physicians, nurses, schedulers, and patient financial services to ensure appropriate authorizations, payer requirements, and seamless communication across teams.

Qualifications

• Education must include a high school diploma or equivalent; degrees preferred as listed.
• Knowledge of medical terminology and coding (CPT/ICD) is required.

Responsibilities

• Manages individual patients across the health care continuum to achieve optimal clinical outcomes.
• Acts in a leadership function with process improvement activities for populations of patients.
• 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 health care team members; communicates pertinent information to payers and others to fulfill utilization and regulatory requirements; works on denials to overturn them.
• Educates internal team on pre-authorizations and managed care concepts; serves as an educational resource to outside facilities; facilitates integration of concepts into daily practice.

Skills

Medical Terminology

CPT/ICD codes

Education

High School Diploma or Equivalent

Degree in Secretarial Administration, Health Care Administration, Business, and/or Accounting preferred

Job description

Great Plains Health in North Platte, Nebraska is seeking an Authorization Specialist to coordinate patient care across the continuum. You will assess care plans, determine resource utilization, and document progress to meet health care needs.

You will work closely with physicians, nurses, schedulers, and patient financial services to ensure appropriate authorizations, payer requirements, and seamless communication across teams.