CentralAuthorizationSpecialist

Henry Ford Health System; Troy (MI); On-site; USD 60,000 - 80,000; Full time

Job summary

Henry Ford Health System in Detroit seeks a Central Authorization Specialist to centrally procure insurance authorizations for procedures and post-operative care, ensuring accuracy through validation and education of staff.

You will work with physicians, nurses, payors, and the revenue cycle team to reduce delays, drive continuous improvement, and manage a defined caseload under supervision.

Qualifications

• High school diploma or equivalent
• 3–5 years in a medical clinic, hospital, or corporate setting
• 2+ years of insurance verification and/or billing experience
• Experience obtaining insurance authorizations and interpreting treatment plans/RN or physician notes
• Knowledge of medical coding, clinical terminology, insurance records, and revenue cycle
• Preferred: medical/surgical specialty clinic experience; knowledge of hospital operations, utilization/case management, and managed care reimbursement
• Highly computer literate; strong data management skills
• Strong written/verbal, interpersonal, and negotiation skills
• Comfortable working with physicians, nurses, payors, patients, finance teams, and leadership
• Strong time management and ability to prioritize multiple tasks
• Able to work independently and resolve issues/authorization roadblocks effectively

Skills

Insurance verification

Authorization proc./precertification

Medical coding

Clinical terminology

Revenue cycle

Communication

Collaboration

Organization

Judgment/independence

Education

High school diploma

Job description

The purpose of the Central Authorization Specialist position is to centrally facilitate the successful procuring of insurance authorizations for ordered procedures and post-operative care. This will be done through quality validations of obtained authorizations as well as continuous education and opportunity feedback to a multi-disciplinary team with the underlying objective of managing the cost of care and providing timely and accurate information to payors. The Central Authorization Specialist helps drive change by identifying areas where performance improvement is needed (e.g., day to day workflow, education, process improvements, patient satisfaction). The Central Authorization Specialist is accountable for a designated caseload and plans effectively in order to meet demands and support resources procuring authorizations. Under general supervision and in accordance with established policies and procedures the specific functions within this role include Subject matter expertise of precertification and payor authorization processes. Ensure successful authorizations are procured by ordering physician offices through validation of work effort and education of procuring staff. Ensure feedback relevant to successful authorization procurement is obtained from back-end coding, billing and denial management resources and distributed to ordering physicians and authorization procurement staff to promote continuous improvement. Application of process improvement methodologies. The responsibilities include acting as a centralized resource for assigned specialty across all sites of practice to ensure standardized and consistent procurement of authorizations.

• Education: High school diploma or equivalent combination of education/experience
• Experience: 3–5 years in a medical clinic, hospital, or corporate setting
• Healthcare: 2+ years of insurance verification and/or billing experience
• Authorization: Experience obtaining insurance authorizations and interpreting treatment plans/RN or physician notes
• Knowledge: Medical coding, clinical terminology, insurance records, and revenue cycle
• Preferred: Medical/surgical specialty clinic experience; knowledge of hospital operations, utilization/case management, and managed care reimbursement
• Technical: Highly computer literate; strong data management skills
• Communication: Strong written/verbal, interpersonal, and negotiation skills
• Collaboration: Comfortable working with physicians, nurses, payors, patients, finance teams, and leadership
• Organization: Strong time management and ability to prioritize multiple tasks
• Judgment: Able to work independently and resolve issues/authorization roadblocks effectively

Additional Information

• Organization: Corporate Services
• Department: CBO Central Authorization Unit
• Shift: Day Job
• Union Code: Not Applicable

This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.

Overview

Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services – from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford’s care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation’s most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers .

The health and overall well-being of our team members is our priority. That’s why we offer support in the various components of our team’s well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.

Equal Employment Opportunity / Aff…

committed to the hiring, advancement and fair treatment of all individuals without regard to

race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,

weight, marital status, family status, gender identity, sexual orientation, and genetic information,

or any other protected status in accordance with applicable federal and state laws.

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