Authorization Specialist Jobs

Authorization Specialist

Salem Hospital, an affiliate of Mass General Brigham, is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve. At Mass General Brigham, we believe in equal access to quality care, employment and advancement opportunities encompassing the full spectrum of human diversity: race, gender, sexual orientation, ability, religion, ethnicity, national origin and all the other forms of human presence and expression that make us better able to provide innovative and cutting-edge healthcare and research.

Reporting to the PAS Manager, the Authorization/Pre-Certification Specialist (APS) ensures that patients demographics and financial information is complete in the hospital’s registration system by working directly with the patient, physician’s office, Central Billing Office and third party payers. The APS determines eligibility and obtains insurance authorizations and pre-certifications from third party payers for all types of admissions/procedures (i.e. day surgery, inpatient and observation). The APS assures compliance with payer regulations in order to generate revenue from various state, federal, and private insurance programs. The APS also acts as a liaison among patients, physician offices, case management, and third party payers ensuring that all third party payers’ requirements are met. The department goal is to maximize reimbursement while serving the needs of our internal and external customers.

• Codes insurance authorization process status in Huron’s OnTrac system and manages the workflow accordingly. Documents and posts all required information in the hospital’s registration system in order for claim to be released and billing cycle to begin.
• Works as part of a group to secure insurance authorizations. Obtains insurance authorizations for all elective and emergency admissions and procedures by providing necessary information as required by third party payers including Admission Worksheet, clinical, PCP referral etc. in an appropriate time frame. Understands notification requirements for date changes and status changes. Requires a complete understanding of coordination of benefits, third party payers and managed care plans.
• Researches and remediates denials to increase hospital revenue. Works closely with the Denials Coordinator to identify trends and how to avoid future denials. Maintains a denial error rate of at or below 0.5% on a consistent basis.
• Appropriately refers patients to the Financial Counseling Department if patient is unable to meet financial obligation or patients with financial liability to resolve prior to date of service.
• Responsible for accuracy and quality of individual work assignment, and a willingness to assist other team members validating the importance and value of team success. Responsible for maintaining work productivity of, at or above 100%.
• Ensures that patient’s demographic and financial information is complete and accurate for all elective and emergent admissions, day surgeries and bedded outpatient encounters. Required to verify patient eligibility and have knowledge of authorization process for various third party payers. Ensures that he/she has the most up-to-date information on any changes to insurance contracts and/or insurance authorization requirements.
• Incorporates new electronic and computer systems when needed ( Huron, software, insurance eligibility, etc.) Able to undergo training for new systems while simultaneously balancing work productivity in current state systems.
• Informs patient and admitting physician of any potential health insurance authorization concerns prior to admission/procedure. Coordinates the authorization and approval process in full compliance with payer rules and regulations. Negotiates and orchestrates clinical conversations between physicians and insurance company in order to get a procedure authorized for service. Works with practice staff to postpone and/or reschedule elective procedures if authorization cannot be obtained prior to date of service.
• Researches and ensures the proper and accurate diagnosis and procedure codes are assigned to the case and/or admission in order to match the authorization obtained.

High School Diploma or GED equivalent.

Ability to read, write and speak English.

Ability to learn payer and department policies and regulations and be able to incorporate them into the daily activities.

Excellent oral and written communication skills.

Excellent organizational and prioritizing skills with the ability to multitask

Ability to problem solve, work under pressure and under very tight deadlines

Energetic team player with positive attitude

Adequate typing skills (40WPM) and familiarity with computers ( Microsoft Outlook, Word, Excel, internet)

Salem Hospital is an Affirmative Action Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.