Clinical Authorization Specialist in Conway, South Carolina at Conway Medical Center

Position Summary: The Authorization Specialist (AS) is assigned patients to obtain insurance to determine if an authorization is required for the testing/procedure being ordered by the requesting physician/practitioner. The Authorization Specialist (AS) will check patient demographics and more importantly insurance information to ensure Conway Medical Center has the most up-to-date information for accurate reimbursement submission. At times you may be responsible for direct nursing care under the supervision of a registered nurse or physician in a patient care area. The AS is responsible for providing exemplary customer service and consistently practicing CMC’s core values of excellence, compassion, healing, teamwork, stewardship, innovation, and integrity. Qualifications:

Education:

• Graduate of an accredited Practical Nurse program required.

Experience

• Previous floor nursing experience preferred.
• Two (2) years of experience in hospital and/or physician billing/pre-authorization or insurance verification.
• Demonstrated knowledge of health insurance plans including Medicare, Medicaid, HMO’s; and PPO’s required.
• Previous Electronic Medical Record (EMR) systems preferred.
• Knowledge of nursing theory and practice required.
• Knowledge of online insurance eligibility and insurance verification systems.

Licensure/Certification/Registration

• Current South Carolina (or compact state) licensure as LPN (SCLLR) in good standing required.
• Basic Life Support (BLS) certification required.

Duties & Responsibilities:

• Collaborates with designated clinical contacts that require escalation to peer-to-peer review.
• Facilitates submission of clean claims and reduction in payer denials by adhering to both organizational and departmental policies and procedures and maintaining departmental productivity and quality goals.
• Educate and counsel patients on their insurance coverage and explain payment options that are available to them.
• Work with front line staff to ensure collections are secured at time of presentation.
• Always displays exemplary core customer service skills.
• Consistently display effective verbal and written communication skills.
• Proficient understanding and use of technology/PC skills required.
• Work well in a fast-paced environment; efficiently organize work and maintain a high level of accuracy and productivity.
• Effectively utilize strong organizational skills.
• Consistently display effective verbal and written communication skills.
• Proficient understanding and use of technology/PC skills required.
• Regularly exercise independent judgment.
• Completes other duties as assigned by department leadership.