Authorization Specialist

Job Title: Authorization Specialist

Reports To: Manager, Utilization Management

Job Summary:

This is a non-exempt position reporting to the Manger, Utilization Management. The position is responsible for administrative activities, including responding to telephone inquiries from physician offices, entering structured clinical data into the electronic authorization system, and providing general support to the Medical Management Team. This position entails no clinical decision making.

Key Responsibilities:

• Complies with local, state, and federal accreditation standards regarding the collection and data entry of structured clinical data.
• Complies with all HIPAA guidelines and regulations.
• Complies with all Medical Management and SIHO policies and procedures.
• Coordinates and streamlines the authorization process by screening for precertification requirements, eligibility, and completeness of information prior to transfer to UR for review.
• Triage incoming calls to the Medical Management Department as well as make calls to providers for UR decisions.
• Work alongside concordant departments at SIHO to effectively manage member and provider needs in a timely manner.
• Enter authorization demographic and structured clinical data into the SIHO authorization system and transfer the requests to the appropriate clinical reviewer.
• Complete non-SIHO delegated authorization entry in the authorization system for claims adjudication.
• Assists in education of provider offices regarding Medical Management processes.
• Performs Medical Management functions that do not require evaluation or interpretation of clinical data.
• Obtains clinical notes and contacts providers as needed in assistance to Utilization Managers for daily functions and care planning.

Minimum Skills Requirement:

• High School diploma or GED required, some college preferred
• Excellent telephone skills
• General knowledge of Microsoft Office software
• Knowledge of medical terminology or willingness to learn
• Good organizational and prioritization skills that are primarily self-directed
• Ability to effectively communicate with all SIHO customers
• Ability to work cohesively as a member of the Medical Management team
• Willingness to be flexible and meet the needs of the department and corporation through changes
• Ability to consistently meet performance requirements
• Professional appearance and presence
• Ability to maintain excellent interpersonal communication in the office environment

Other:

• Confirmation of excellent attendance record
• General Knowledge and understanding of an office environment