EvergreenHealth
Authorization Specialist-General Surgery Care
EvergreenHealth, Kirkland, Washington, United States, 98034
Wage Range: $21.60 - $34.56
Posted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity.
Job Summary:Expedites the administrative requirements for patient care, including clinical authorizations based on specialty provider orders, dealing directly with health plans. Makes decisions and authorizes risk planning referrals, utilizing department and organizational guidelines. Requires daily interaction with patients, staff, healthcare providers, and insurance companies. All job functions are carried out within the EvergreenHealth Medical Group clinic(s) to which assigned.Primary Duties1. Accurately and successfully processes authorizations for medications, procedures, imaging, infusions, surgeries, etc. ordered by clinic providers by working directly with health plans.2. Minimizes care delays by avoiding denials and peer-to-peer escalation between payers and providers.3. Maintains written best practice guidelines for each service and each payer, expanding on the contracted payer list to include coverage requirements, documentation, and authorization submission requirements for successful approval.4. Serves as main point of contact and escalation point for clinical and non-clinical colleagues regarding insurance authorizations.5. Develops and provides clinic staff training on insurance plan requirements and coverage for authorization of medications, procedures, imaging, infusions, etc.6. Educates and periodically reviews workflow related to non-covered services, price quotes, etc. with front office staff.7. Maintains charge masters for department, including fee structure, and makes recommendations for changes to the management team.8. Addresses and resolves patient complaints regarding charges by liaising with Professional Billing and Patient Financial Services on behalf of the patient, including following up with patients directly.9. Attends and participates in all departmental meetings and activities.10. Answers phone lines in support of care coordination when needed.11. Backs up front and back-office colleagues with records requests, chart prep, scanning, scheduling, and other admin care coordination work when needed for patient flow and safety.12. Performs other duties as assigned.
Accountabilities/Competencies1. Proficiency in reading, writing, comprehending and speaking English as required for business necessity.2. Accountability for HIPAA privacy and security standards within the department or assigned nursing unit.3. Must possess basic skills to use Microsoft Office, specialized software and electronic office equipment.4. Assists and advises patients, staff, and specialists regarding the referral authorization process.5. Provides support to patients, providers, and staff regarding medical insurance benefits.6. Maintains procedure manuals.7. Provides back up support to clinic coordinator.8. Accurately collects and documents patient demographics, insurance coverage, provider orders, procedures scheduled and authorization obtained for services as needed.9. Maintains flexibility in job assignments with attention to detail.10. Works assigned queues and supports team with other queues as needed.11. Maintains a positive working relationship with physician offices, other departments and coworkers.12. Demonstrated knowledge of insurance payers and the use of the electronic verification system.13. Excellent communication skills with a high degree of tact and poise to deal effectively with patients, physicians and hospital staff members.14. Works independently to manage work volume and disseminates status updates to other team members as needed.15. Utilizes clinical and referral computer programs to complete responsibilities.16. Expected to handle many details with a clear understanding of the larger system and how patient care decisions need to be processed and communicated.
REQUIRED:* Associate degree or equivalent combination of education and experience* 3 years of experience in a healthcare insurance or related medical office setting* General clinical knowledge related to medications, procedures, imaging, infusions, etc.* Working knowledge of ICD10 and CPT codes* Working knowledge of insurances, Medicare, DSHS, Labor and Industries, and other third-party insurances* Medical Terminology, medical billing, and computer skills* Ability to be flexible and relate well with others in a professional and pleasant manner* Knowledge of medical records confidentiality* Excellent communication skills with a high degree of tact and poise to deal effectively with patients, physicians, and hospital staff members
DESIRED for the position:* Recent specialty clinic authorization experience for medications, procedures, imaging, infusions, surgeries, etc.
Benefit Information:Choices that care for you and your family At EvergreenHealth, we appreciate our employees commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.
Medical, vision and dental insuranceOn-demand virtual health careHealth Savings AccountFlexible Spending AccountLife and disability insuranceRetirement plans (457(b) and 401(a) with employer contribution)Tuition assistance for undergraduate and graduate degreesFederal Public Service Loan Forgiveness programPaid Time Off/VacationExtended Illness Bank/Sick LeavePaid holidaysVoluntary hospital indemnity insuranceVoluntary identity theft protectionVoluntary legal insurancePay in lieu of benefits premium programFree parkingCommuter benefitsView a summary of our total rewards available to you as an EvergreenHealth team member by clicking on the link below. 2024 Benefits Guide
Please see job description
PI243818450
Posted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity.
Job Summary:Expedites the administrative requirements for patient care, including clinical authorizations based on specialty provider orders, dealing directly with health plans. Makes decisions and authorizes risk planning referrals, utilizing department and organizational guidelines. Requires daily interaction with patients, staff, healthcare providers, and insurance companies. All job functions are carried out within the EvergreenHealth Medical Group clinic(s) to which assigned.Primary Duties1. Accurately and successfully processes authorizations for medications, procedures, imaging, infusions, surgeries, etc. ordered by clinic providers by working directly with health plans.2. Minimizes care delays by avoiding denials and peer-to-peer escalation between payers and providers.3. Maintains written best practice guidelines for each service and each payer, expanding on the contracted payer list to include coverage requirements, documentation, and authorization submission requirements for successful approval.4. Serves as main point of contact and escalation point for clinical and non-clinical colleagues regarding insurance authorizations.5. Develops and provides clinic staff training on insurance plan requirements and coverage for authorization of medications, procedures, imaging, infusions, etc.6. Educates and periodically reviews workflow related to non-covered services, price quotes, etc. with front office staff.7. Maintains charge masters for department, including fee structure, and makes recommendations for changes to the management team.8. Addresses and resolves patient complaints regarding charges by liaising with Professional Billing and Patient Financial Services on behalf of the patient, including following up with patients directly.9. Attends and participates in all departmental meetings and activities.10. Answers phone lines in support of care coordination when needed.11. Backs up front and back-office colleagues with records requests, chart prep, scanning, scheduling, and other admin care coordination work when needed for patient flow and safety.12. Performs other duties as assigned.
Accountabilities/Competencies1. Proficiency in reading, writing, comprehending and speaking English as required for business necessity.2. Accountability for HIPAA privacy and security standards within the department or assigned nursing unit.3. Must possess basic skills to use Microsoft Office, specialized software and electronic office equipment.4. Assists and advises patients, staff, and specialists regarding the referral authorization process.5. Provides support to patients, providers, and staff regarding medical insurance benefits.6. Maintains procedure manuals.7. Provides back up support to clinic coordinator.8. Accurately collects and documents patient demographics, insurance coverage, provider orders, procedures scheduled and authorization obtained for services as needed.9. Maintains flexibility in job assignments with attention to detail.10. Works assigned queues and supports team with other queues as needed.11. Maintains a positive working relationship with physician offices, other departments and coworkers.12. Demonstrated knowledge of insurance payers and the use of the electronic verification system.13. Excellent communication skills with a high degree of tact and poise to deal effectively with patients, physicians and hospital staff members.14. Works independently to manage work volume and disseminates status updates to other team members as needed.15. Utilizes clinical and referral computer programs to complete responsibilities.16. Expected to handle many details with a clear understanding of the larger system and how patient care decisions need to be processed and communicated.
REQUIRED:* Associate degree or equivalent combination of education and experience* 3 years of experience in a healthcare insurance or related medical office setting* General clinical knowledge related to medications, procedures, imaging, infusions, etc.* Working knowledge of ICD10 and CPT codes* Working knowledge of insurances, Medicare, DSHS, Labor and Industries, and other third-party insurances* Medical Terminology, medical billing, and computer skills* Ability to be flexible and relate well with others in a professional and pleasant manner* Knowledge of medical records confidentiality* Excellent communication skills with a high degree of tact and poise to deal effectively with patients, physicians, and hospital staff members
DESIRED for the position:* Recent specialty clinic authorization experience for medications, procedures, imaging, infusions, surgeries, etc.
Benefit Information:Choices that care for you and your family At EvergreenHealth, we appreciate our employees commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.
Medical, vision and dental insuranceOn-demand virtual health careHealth Savings AccountFlexible Spending AccountLife and disability insuranceRetirement plans (457(b) and 401(a) with employer contribution)Tuition assistance for undergraduate and graduate degreesFederal Public Service Loan Forgiveness programPaid Time Off/VacationExtended Illness Bank/Sick LeavePaid holidaysVoluntary hospital indemnity insuranceVoluntary identity theft protectionVoluntary legal insurancePay in lieu of benefits premium programFree parkingCommuter benefitsView a summary of our total rewards available to you as an EvergreenHealth team member by clicking on the link below. 2024 Benefits Guide
Please see job description
PI243818450