Revenue Authorization Specialist II

Revenue Authorization Specialist II

POSITION DESCRIPTION :

This position is remote, but does need to reside in the state of Michigan.

The Revenue Authorization Specialist II is responsible for all aspects of the authorization / pre-certification, referral process and identifies amendments / retros to help maximize revenue for departments when CPT (Current Procedural Technology) codes for technologies and services change. Assists in maintaining charge review and claim edit registration work queues and identifying trends to optimize workflows / education needed.

ESSENTIAL JOB FUNCTIONS :

• Contacts insurance companies via appropriate methods and obtains pre-certifications and authorizations.
• Obtains urgent authorizations same day, next day.
• Verifies correct procedural and diagnostic codes and insurance verification.
• Monitors in basket, email, and fax server if applicable. Follows up on correspondence timely and accurately.
• Monitors authorizations or denials and follows up, as necessary.
• Generates authorization information for physicians, patients, and health plans.
• Obtains pre-certifications, insurance and testing authorizations for medical procedures.
• Communicates denials to appropriate staff and next steps.
• Acts as a liaison among providers, staff, health plan administrators and hospital representatives.
• Relays clinical information to health plan case managers for special procedure pre-certification and out-of-plan or out-of-network referrals; monitors authorizations or denials and follows up, as necessary.
• Communicates referral status to staff and physicians; ensures that authorizations have been processed accurately and in a timely manner to coincide with patient treatment plan.
• Assists offices in resolving billing discrepancies and any other referral / authorization issues.
• Participates in revenue targeted projects and addresses opportunities and barriers as they arise.
• Answers incoming calls.
• Supports other offices, attends required meetings and training, performs research, e-learning to stay current on best practices and participates in committees as requested.
• Handles amendments and retro-authorizations to recoup revenue.
• Handles retro-authorizations in the retro-authorization work queue.
• Identifies opportunities to prevent denials future state.
• Assumes ownership of the PB REG Newborn Review work queue.
• Resolves issues in the Hospital PB REG Charge Review and Claim Edit work queues.
• Assists with special projects and assumes additional duties as assigned. Scans and files documents.

ORGANIZATIONAL EXPECTATIONS :

MEASURED BY :

Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position.

ESSENTIAL QUALIFICATIONS :

EDUCATION : Associate degree in health care or a related field and specialized training or equivalent combination of education and experience.

CREDENTIALS / LICENSURE : None

MINIMUM EXPERIENCE : 3 to 4 years’ experience with insurance referrals, prior authorization or other relevant professional revenue cycle experience.

POSITION REQUIREMENTS (ABILITIES & SKILLS) :

MINIMUM PHYSICAL EXPECTATIONS :

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