Authorization Specialist

Texas Children's Hospital•Houston, TX

About The Position

We are searching for an Authorization Specialist – someone who works well in a fast-paced setting. In this position, you’ll be responsible for supporting the pre-admission and admission process, ensuring financial authorization for service is obtained and to providing the authorizing entity with clinical information, including diagnosis and treatment plan, to secure authorization. This role will be primarily responsible for acting as a liaison with the payer representatives, collaboration with providers if medical necessity issues are questioned by payers, and facilitation of communication between providers and payers. Think you’ve got what it takes?

Requirements

2 years of experience in patient access registration required
High School Diploma or GED

Nice To Haves

Licensed Vocational Nurses certificate is preferred
National Certified Medical Assistant certificate is preferred
Emergency Medical Technician certificate is preferred

Responsibilities

Secures finances to maximize reimbursement in a customer service-oriented fashion
References the contractual agreements with insurance companies to obtain authorization for services
Uses communication skills to facilitate non-hospital employee compliance in providing necessary information for authorization
Provides the highest possible customer service
Obtains clinical and financial authorization as required by contract for services
Reviews and acts to secure accounts requiring additional clinical information to extend authorization periods
Obtains retro-authorizations, if necessary, on accounts in which services have already been provided
Facilitates provider communication with payer representative and/or payer Medical Director
Refers any denials of services or cases with questioned medical necessity to the referring physician or his/her designee for additional information
Verifies authorization requirements with payer representatives and communicates all necessary information to hospital staff
Provides complete and accurate documentation in EPIC regarding authorizations
Provides continuous support of process improvements through compilation of data, excellent customer service, monitoring and evaluating departmental roles, and proposals for process improvement initiatives
Responds to requests from supervisor and customers for authorizations, written or verbal reports (operational, follow-up, financial, etc.) and tasks by the established deadline as observed by supervisor