• The Authorization Specialists are responsible for verifying patient insurance eligibility and coverage and securing third party payer authorization for services to be rendered on behalf of Madisonhealth.

Required Skills:

1. Completes accurate and timely insurance verification.

2. Completes accurate and timely third party payer authorization requests, including ensuring all necessary data elements needed for an authorization (e.g., CPT codes, diagnosis codes) are available.

3. Ensures services scheduled by outside providers have approved authorization as required by payer and procedure prior to service.

4. Communicates with patients, insurers, and other appropriate parties pertaining to insurance verification and authorization.

5. Escalates financial clearance risks as appropriate in compliance with the Financial Clearance Program.

6. Provides clear documents for financial clearance work according to Standard Documentation Guidelines.

7. Notifies Hospital Utilization Review and/or Admitting offices of reviews completed for urgent, elective, uninsured/underinsured admissions and outpatient procedures requiring discharge planning after admission to inform the hospital of authorized services, length of stay and outcomes necessary if concurrent review is necessary during the hospital stay.

8. Refers underinsured/uninsured patients and/or point-of-service pre-payment required services to the Pre-Service Patient Financial Responsibility and/or Financial Assistance team(s) to determine if the patient is eligible for assistance and obtain payment prior to services being received, when applicable, to help manage the organizations bad debt.

9. Creates a positive patient experience by being polite, compassionate, and professional.

10. Provides cross-coverage and training, when needed, for other team members.

11. Maintains productivity and quality performance expectations.

12. Regular attendance is required to carry out the essential functions of the position.

13. Reviews and meets ongoing competency requirements of the role to maintain the skills, knowledge, and abilities to perform, within scope, role specific functions

Minimum Work Experience:

1. Two years’ experience in a medical business office or health care setting involving customer service or patient-facing responsibilities, or equivalent experience.

Minimum Education:

1. High school diploma or equivalent.

2. Preferred/Optional: Successful completion of post-secondary courses in Medical Terminology and Diagnosis and CPT Coding, and Anatomy & Physiology. Graduate of a Medical Assistant, Health Unit Coordinator or Health Care Business Service program.