Authorization Specialist- Case Manager (Full Time, Days)

Description

*This position is located at Nicklaus Children's Hospital; role is supporting Coral Springs & Broward Health Medical Center.

Job Summary

Responsible for insurance verification and obtaining authorization for inpatient, outpatient, observation, extended stay outpatient in bed, and inpatient admissions including concurrent authorization requests, retroactive authorization modifications, and discharge notifications as appropriate. Works in conjunction with UM Coordinator for the management of denials. 

Job Specific Duties

• Communicates to clinical team and other departments managed care requests via established work flows.
• Provides and documents adequate notification, accurate records of insurance notes, denials, and authorizations. 
• Responds to inquiries, and escalates as appropriate any authorization issues or denials.
• Monitors admissions, continued-stay, and discharge patients to ensure accurate authorizations are obtained.
• Secures authorization for all inpatient admissions, outpatient, and elective extended procedures stay in a bed. 
• Verifies insurance benefits documents accurately in computer system. 
• Provides verifications and authorizations within 24 hours of in-patient-bed assignment. 
• Reconciles “Discharge Not Final Bill” encounters, and documents in approved computer system authorization status within established timeframe. 
• Reconciles daily/weekly census with managed care companies. 

Qualifications

Minimum Job Requirements

• 2 years of customer service experience
• 2 years of health plans, Medicaid, commercial payers, and Market Place experience

Knowledge, Skills, and Abilities

• High school education or equivalent preferred.
• One year of experience working with medical terminology, procedures, diagnosis codes, and insurance preferred.
• Prior experience working with CPT and ICD10 Coding preferred.
• Intermediate proficiency in Microsoft Word, Excel and Outlook.
• Able to communicate effectively both verbally and in writing in a clear, concise, courteous, and prompt manner with all internal and external customers.
• Fluent in Spanish preferred.
• Able to maintain confidentiality of sensitive information.
• Able to work in a fast paced environment, and possesses strong organizational skills including priority setting, planning, decision making, and effective management and use of resources to meet the competing deadlines of a variety of tasks, problems, and projects.
•  Able to work in a team, build consensus, influence others, and handle conflicts with tact.
• Able to establish necessary professional relationships, and interact effectively with internal and external customers.
• Able to adapt and react calmly under stressful conditions in pleasant manner.
• Able to learn work related software application(s) and effectively use them.
  

Job:

Department:

Job Status: