Medical Authorization Specialist Jobs

Medical Authorization Specialist

LifeNet Health is searching for talented individuals who will embrace our mission of saving lives, restoring health, and giving hope.

LifeNet Health, headquartered in Virginia Beach, Virginia, is the largest nonprofit organ procurement organization (“OPO”) and tissue processor in the United States, as well as a leading innovator in tissue engineering and regenerative medicine. Our goal is to improve the quality of human life through the provision of organs, tissues and cells for transplantation; to provide innovation in the fields of bio-implants, regenerative medicine and research; and, to serve the community with educational and support services that enhance the donation process. LifeNet Health has over 1200 employees and has a growing global presence.

How you will contribute to LifeNet Health’s success:

The Medical Authorization Specialist (MAS) will support the reimbursement strategy of the company by aggressively pursuing authorization and reimbursement while establishing a resource of expertise for the payers. The MAS will demonstrate, through actions, a consistent performance standard of excellence.

What you’ll do:

• Submits pertinent demographic and supporting clinical documentation with pre-authorization requests timely to avoid unnecessary delays in patient treatment.
• Performs on-going check and balance system to ensure the integrity of the patient billing data.
• Reviews and interprets medical record documentation for patient history, diagnosis, and previous treatment plans.
• Completes all required training in a satisfactory and timely manner.
• Works with the Order Management team to secure any additional information and medical documentation from the patient and/or prescribing HCP.
• Operates in a compliant manner by keeping patient data secure and confidential and adhering to all company policies and procedures.
• Holds oneself and others accountable to conduct business in a manner compliant with Code of Compliance and Ethics, policies and procedures and internal controls applicable to their role.
• Complies with all health, safety and environmental policies, procedures and job hazard analyses applicable to specified job activities including medical evaluations as required by job function.
• Maintains and documents complete, timely, and accurate patient insurance and billing information.
• Utilizes payer-specific approved criteria to determine medical necessity or the clinical appropriateness for the company’s products.

What you’ll bring (Minimum Requirements):

• High School diploma or GED
• One (1) year previous experience of insurance verification or medical authorization experience involving medical record review.

These would be nice too (Knowledge Skills and Abilities)

• Attention to Detail: Able to perform tasks thoroughly and with care; checks work to ensure high degree of accuracy/completeness and early/on-time delivery

• Medical terminology and ICD-10 coding: Knowledge of and interpretation skills
• MS Office Proficiency: PowerPoint, Excel, Word, Outlook, Microsoft Suite
• Time Management: Able to prioritize multiple, competing priorities and manage time/workload. Demonstrated ability to effectively prioritize and juggle multiple time sensitive projects, multi-task, identify project interdependencies and potential risks/pitfalls.
• Communication Skills: Excellent verbal and written communication skills; ability to communicate and build relationships with all professionals at different levels within the organization.

Why work at LifeNet Health?
We have a fierce drive for our mission of Saving Lives, Restoring Health, and Giving Hope. You won’t find another company with a culture as strong as ours.

• Employee Assistance Program (EAP) for employees and members of their household
• Corporate sponsored events for employees
• Affordable medical, dental, and vision coverage
• Work-life balance with generous paid time off to include vacation time, sick time, and paid holidays
• Dedicated and passionate co-workers
• Tuition reimbursement
• Personal career, skill, and leadership development opportunities
• 403(b) and Profit-Sharing Plan
• Wellness Program (gym reimbursement, monthly wellness webinars, mental health toolkit, financial resources, and much more)

We are proud to be an EEO/AA employer EOE/M/F/Disability/Vet. We maintain a drug-free workplace and perform pre-employment substance abuse testing.