Authorization Specialist - PreService - Customer Care Contact Center - Business Services Group

 
Position: Authorization Specialist - PreService - Customer Care Contact Center - Business Services Group

Job ID: 155281

Location: US-TX-Houston

Department: CONTACT CENTER - PRE-SERVICE

Talent Area: Clinical Support

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 7a - 7p Monday - Friday

About Texas Children's Hospital

Since 1954, Texas Children’s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children’s hospital in Texas, and among the top in the nation by U.S.News & World Report as well as recognition from Houston Business Journal as one of this city’s Best Places to Work for ten consecutive years.   Texas Children’s comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Center for pediatric research; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children’s Hospital West Campus, a community hospital in suburban West Houston; and Texas Children’s Hospital The Woodlands, the first hospital devoted to children’s care for communities north of Houston. We have also created the nation’s first HMO for children, established the largest pediatric primary care network in the country and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is also academically affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation.   To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.    

Summary:

We are searching for an Authorization Specialist – someone who works well in a fast-paced setting. In this position, you’ll be responsible for supporting the pre-admission and admission process, ensuring financial authorization for service is obtained and to providing the authorizing entity with clinical information, including diagnosis and treatment plan, to secure authorization. This role will be primarily responsible for acting as a liaison with the payer representatives, collaboration with providers if medical necessity issues are questioned by payers, and facilitation of communication between providers and payers.

 

Think you’ve got what it takes?



Responsibilities :

Job Duties & Responsibilities

 

  • Secures finances to maximize reimbursement in a customer service-oriented fashion
  • References the contractual agreements with insurance companies to obtain authorization for services
  • Uses communication skills to facilitate non-hospital employee compliance in providing necessary information for authorization
  • Provides the highest possible customer service
  • Obtains clinical and financial authorization as required by contract for services
  • Reviews and acts to secure accounts requiring additional clinical information to extend authorization periods
  • Obtains retro-authorizations, if necessary, on accounts in which services have already been provided
  • Facilitates provider communication with payer representative and/or payer Medical Director
  • Refers any denials of services or cases with questioned medical necessity to the referring physician or his/her designee for additional information
  • Verifies authorization requirements with payer representatives and communicates all necessary information to hospital staff
  • Provides complete and accurate documentation in EPIC regarding authorizations
  • Provides continuous support of process improvements through compilation of data, excellent customer service, monitoring and evaluating departmental roles, and proposals for process improvement initiatives
  • Responds to requests from supervisor and customers for authorizations, written or verbal reports (operational, follow-up, financial, etc.) and tasks by the established deadline as observed by supervisor


Qualifications:

Skills & Requirements

 

  • 2 years of experience in patient access registration required
  • Licensed Vocational Nurses certificate is preferred
  • National Certified Medical Assistant certificate is preferred
  • Emergency Medical Technician certificate is preferred
  • Knowledge of managed care industry and the working philosophy for its success
  • Knowledge of indemnity coverage plans and government resources, specifically Medicaid and CIDC
  • Knowledge of disease processes of pediatric nature, disease diagnoses, procedure codes, and drug codes
  • Knowledge of patient accounting principles and managed care business practices is helpful
  • Ability to predict outcomes based on existing processes and/or checks and balances
  • Ability to use a networked personal computer that facilitates access to the hospital’s EPIC electronic medical record system
  • Ability to use basic office software, photocopiers, fax machines, desk calculator, and multi-line telephone
  • Typing speed of 45-60 words per minute
  • Ability to provide excellent customer service, and demonstrate self-initiated work behaviors, good verbal communication skills, problem solving, and strong organization skills


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