Pre-Access Authorization Consumer Access Specialist

1103 Team Member Services; United States; On-site; USD 22,000 - 34,000; Full time

Benefits offered by this job

Medical

Dental

Vision Insurance

Life Insurance

Disability Insurance

Paid Time Off from Day One

403-B Retirement Plan

4 Weeks 100% Paid Parental Leave

Career Development

Whole Person Well-being Resources

Mental Health Resources and Support

Pet Benefits

Job summary

AdventHealth in Georgia is seeking a full-time Authorization Specialist to obtain prior authorizations, review medical necessity, and coordinate payer communications. You will document authorizations, verify benefits, and support the clinical care team to ensure compliant, timely approvals.

This role requires a high school diploma or equivalent and attention to detail, with opportunities for professional development within a faith-based health system.

Qualifications

• Validation is required.
• High school diploma or GED required.

Responsibilities

• Obtains prior authorization or pre-certification of services for payment by insurance companies, including CMS and state programs.
• Submits clinical documentation for approval to payors and ensures medical necessity criteria are met.
• Acts as a liaison with the clinical care team to ensure compliance with payer guidelines.
• Participates in clinical performance improvement initiatives related to documentation and quality utilization.
• Coordinates communication between business and clinical operations.
• Distributes information to ancillary departments and verifies eligibility and benefits as needed.
• Accurately documents prior authorization information in EMR and other systems.
• Communicates with physician offices regarding the status of requests.
• Ensures all scheduled testing meets Medicare medical necessity standards.
• Obtains patient demographic and insurance information from new patients and enters it into the computer.
• Treats patients and their families with respect and dignity while ensuring confidentiality of patients’ records.
• Provides information about patient rights and HIPAA.
• Other duties as assigned.

Skills

Validation

Education

High School Grad or Equiv

GED

Job description

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better. All the benefits and perks you need for you and your family: Benefits from Day One:

• Medical
• Dental
• Vision Insurance
• Life Insurance
• Disability Insurance
• Paid Time Off from Day One
• 403-B Retirement Plan
• 4 Weeks 100% Paid Parental Leave
• Career Development
• Whole Person Well-being Resources
• Mental Health Resources and Support
• Pet Benefits

Schedule: Full time Shift: Day (United States of America) Address: 1035 RED BUD RD NE City: CALHOUN State: Georgia Postal Code: 30701

Pay Range: $16.05 - $25.67

Job Description:

• Obtains prior authorization or pre-certification of services for payment by insurance companies, including CMS and state programs.
• Submits clinical documentation for approval to payors and ensures medical necessity criteria are met.
• Acts as a liaison with the clinical care team to ensure compliance with payer guidelines.
• Participates in clinical performance improvement initiatives related to documentation and quality utilization.
• Coordinates communication between business and clinical operations.
• Distributes information to ancillary departments and verifies eligibility and benefits as needed.
• Accurately documents prior authorization information in EMR and other systems.
• Communicates with physician offices regarding the status of requests.
• Ensures all scheduled testing meets Medicare medical necessity standards.
• Obtains patient demographic and insurance information from new patients and enters it into the computer.
• Treats patients and their families with respect and dignity while ensuring confidentiality of patients’ records.
• Provides information about patient rights and HIPAA.
• Other duties as assigned.

Knowledge, Skills, and Abilities:

• Validation [Required]

Education:

• High School Grad or Equiv [Required]

Field of Study:

• or GED

Physical Requirements:

Physical Requirements - https://tinyurl.com/23km2677

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

Every day, our fellow team members show up to work, unified by one shared mission: Extending the Healing Ministry of Jesus Christ. As a faith-based health care organization, our story is one of hope as we strive to heal and restore the body, mind and spirit. Though our facilities are spread across the country, this unwavering belief binds us together. Across every office, exam and patient room, we’re committed to providing individualized, holistic care. This is our Christian mission, and it inspires us to help make communities healthier and happier.