Authorization Specialist. at Metro Community Health Center – Pittsburgh, Pennsylvania

• Demonstrate a high level of skill at building relationships and customer service
• Demonstrate interpersonal savvy and influence skills in managing difficult clients and patients
• Demonstrate high degree of knowledge and competency in the practice of medicine and associated charting requirements
• Demonstrate a high level of problem-solving skills to better serve patients and staff
• Strong attention to detail and accuracy
• Ability to utilize computers for data entry and information retrieval
• Excellent verbal and written communication skills.
• Continually improve work process to enhance service and customer relations
• Works to improve prior authorization processes, communication, and patient care as it relates to various insurance companies’ regulations.
• Demonstrated success and familiarity with tools, technology, and systems typically found within most progressive health care environments (i.e. personal computer skills, spreadsheets, word processing, patient records systems, EMR systems, etc.)
  • Experience with insurer’s authorization submission portals preferred
• Responsible for receiving, processing and documenting referral and prior authorization requests (medications, test/procedures, DMEs, etc.).
• Stay abreast of continual changes in the health insurance Managed Care arena and communicates those changes as appropriate.
• Assists the clerical and clinical teams with the coordination of patients
• Have an understanding of provider charting practices and how to find supporting documentation inside the patient chart
• Attend meetings, patient conferences, planning sessions, related to quality assurance, patient care, and other related topics within the health center
• Attend seminars and maintain all certifications requirements for continuing education and best practices
• Participate in quality strategies to evaluate compliance with standards and to identify opportunities to improve patient outcomes
• Assists the clinical team with quality assurance standards and measures
• Ability to utilize computers for data entry and information retrieval
• Excellent verbal and written communication skills in a professional manner
• Ability to implement, and evaluate operational and administrative processes
• Maintains HIPAA compliance practices at all times
• Ensures insurance carrier documentation requirements are met and referral support documentation is charted in patient's medical record.
• Efficiently manages correspondence with patients, physicians, specialists, and insurance companies.
• Work in coordination with medical providers regarding issues in documentation, diagnoses, etc in regard to patient’s prior authorizations.
• Work in coordination with medical providers regarding denials to ensure quality patient outcomes.
• Documents pertinent information in the patient record regarding authorizations and communications with patients.
• Works in collaboration with the Financial Department to improve the Revenue Cycle
• Performs other duties as assigned

• High school diploma or equivalent
• 3-5 years of prior experience performing authorizations and referrals
  • Some combination of education/certification may be accepted in lieu of experience.
  • Education Equivalent

Skills/Abilities

• Demonstrated experience of developing an effective rapport with the patients, staff members, insurance companies, etc. in an effort to provide comprehensive healthcare across the life span.
• Significant knowledge of medical practices and insurance within a primary care environment
• Knowledge of relevant prior authorization portals
• Knowledge of formularies and other insurance related procedures regarding prior authorizations
• Communication Skills
• Knowledge and understanding of EMR software. Athena One experience preferred.
• Medical Terminology
  • CPT
  • ICD-10
• Customer Service
• Computers/Microsoft Office Suite (Excel, Word, Etc)
• Medical Insurance Knowledge
  • Medicare/Medicaid
  • Private Payers