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Charlotte, NC, United States
Job ID: 136079
Job Family: Patient Accounting/Registration
Status: Full Time
Shift: Day
Detailed Shift and Schedule: Monday - Friday 730-4
Job Type: Regular
Department Name: 33151017240504-Administration - Operations
Overview
Primary PurposeThe Advanced Authorization Specialist is responsible for all aspects involved in obtaining highly complex authorizations for a multitude of In-patient and Out-patient Services. The Advanced Authorization Specialist must be knowledgeable and have a thorough understanding of Commercial and Government payors with regards to Coordination of Benefits, Authorization guidelines, Pharmacy and Medical Benefit variances, as well as Medical Necessity Policies. The Advanced Authorization Specialist is responsible for reading and interpreting various complex medical records to obtain authorizations for requested services and treatment plans. Communication with clinic staff, providers, Pharmacists, and insurance companies is essential to ensure completed peer reviews, relay updated medical and specialty drug policies, and appeals. They work closely with the Hospital and Provider Denial Management Teams to review monthly denials and assess opportunities for retro-active authorizations and determine root cause analysis.Major Responsibilities
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Minimum Job Requirements
Education |
Bachelor’s Degree or 3 years of authorization experience required. |
Work Experience |
Bachelor’s Degree or 3 years of authorization experience required. |
Knowledge / Skills / Abilities |
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Physical Requirements and Working Conditions
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DISCLAIMER
All responsibilities and requirements are subject to possible modification to reasonably accommodate individuals with disabilities.
This job description in no way states or implies that these are the only responsibilities to be performed by an employee occupying this job or position. Employees must follow any other job-related instructions and perform any other job-related duties requested by their leaders.