Confluence Health
Salary Range
$17.67 - $28.19 Overview
Located in the heart of Washington, we enjoy open skies, snow-capped mountains, and the lakes and rivers of the high desert. We are the proud home of orchards, farms, and small communities. Confluence Health actively supports the communities we serve and their quality of life through our community support program and through our individual efforts as involved community members.
Employees of Confluence Health receive a wide range of benefits in addition to compensation.
Medical, Dental & Vision Insurance Flexible Spending Accounts & Health Saving Accounts CH Wellness Program Paid Time Off Generous Retirement Plans Life Insurance Long-Term Disability Gym Membership Discount Tuition Reimbursement Employee Assistance Program Adoption Assistance Shift Differential For more information on our Benefits & Perks, click here!
Summary
The Outpatient Authorizations Specialist II is responsible for determining when an authorization is required for healthcare services and for submitting prior authorization requests in accordance with health plan requirements. Documents all authorization information and determinations in the patient's electronic medical record. Proper execution of this work directly impacts revenue for the organization and supports its denial management and prevention strategies.
Position Reports To:
Authorizations Manager
Essential Functions
Researches prior authorization requirements and submits prior authorization requests in a timely manner. Researches, recognizes, requests, and submits the clinical documentation required to support the medical necessity of the service being authorized. Properly documents all authorization requests and decisions in the patient's auth/cert or referral record utilizing standard EPIC workflows and work queues. Accurately interprets medical policies and how they pertain to services being authorized. Utilizes payor tools and websites as needed to facilitate prior authorization requests. Verifies insurance eligibility and benefits and updates patient insurance information as needed. Reviews and resolves all reported authorization issues. Proactively researches and stays informed of changing insurance pre-authorization requirements and health plan updates. Communicates with providers, Staff, and Patients to keep them apprised of the status of the authorization requests and processes denied authorizations in a timely manner. Keeps pace with workflow by remaining up to date on work and preventing backlog in workflows. Collaborates with teammates and leadership to identify process improvements and optimizations. Advises leadership of payor trends and issues. Develops and maintains positive rapport with both internal and external customers. Participates in team huddles, meetings, and trainings as required by leadership to maintain collaboration, continuing education, and team synergy. Collaborate with other SME's, Outpatient Authorizations Lead and the Outpatient Authorization Manager to establish best practice standards. Continually improve work process to enhance service and customer relations. Investigate authorization denials and assists with appeals. Troubleshoot escalated requests from staff and providers and problem solves for difficult and unusual authorizations and referrals. Assists in problem identification, quantification, and resolution. Provide education and communication to providers and staff regarding prior authorization requirements by payor and procedure/service. Performs other duties as assigned.
Demonstrate Standards of Behavior and adhere to the Code of Conduct in all aspects of job performance at all times.
Qualifications
Required:
High School Diploma or equivalent. Demonstrated experience with insurance requirements for referrals and/or prior authorizations to various therapies, surgeries, procedures, diagnostic testing, etc. Experience investigating denials. Possesses intermediate computer skills (e.g., spreadsheets, word processing); knowledge of MS Office. Effective written and verbal communication skills. Effective reading comprehension skills. Demonstrated customer service experience in an office or clinical setting. Ability to multi-task and thrive in a dynamic and fast-paced environment. Ability to prioritize workload and meet deadlines while being flexible to the changing demands of coverage. EHR proficiency. 2 years working in a healthcare setting as an Authorization Specialist or a certification/credential in one of the following: AAHAM - CRCS; AAPC - CPC; or MA-C. Desired:
Associates degree. Experience in CPT/ICD-10 coding. EPIC experience in Prelude, Cadence, Grand Central, and/or Resolute applications. Physical/Sensory Demands
O = Occasional, represents 1 to 25% or up to 30 minutes in a 2 hour workday. F = Frequent, represents 26 to 50% or up to 1 hour of a 2 hour workday. C = Continuous, represents 51% to 100% or up to 2 hours of a 2 hour workday.
Physical/Sensory Demands For This Position:
Walking - F Sitting/Standing - C Reaching: Shoulder height - F Reaching: Above shoulder height - O Reaching: Below shoulder height - F Climbing - O Pulling/Pushing: 25 pounds or less - O Pulling/Pushing: 25 pounds to 50 pounds - O Pulling/Pushing: Over 50 pounds - O Lifting: 25 pounds or less - F Lifting: 25 pounds to 50 pounds - O Lifting: Over 50 pounds - O Carrying: 25 pounds or less - O Carrying: 25 pounds to 50 pounds - O Carrying: Over 50 pounds - O Crawling/Kneeling - O Bending/Stooping/Crouching - F Twisting/Turning - F Repetitive Movement - C Working Conditions:
Normal office environment which consists of sitting at a desk for long periods of time, talking on a telephone, working on a computer, and processing paperwork. The office environment may consist of clinical office, business office, or home office depending on need. Job Classification:
FLSA : Non-exempt Hourly/Salary : Hourly Physical Exposures For This Position:
Unprotected Heights - No Heat - No Cold - No Mechanical Hazards - No Hazardous Substances - No Blood Borne Pathogens Exposure Potential - Yes Lighting - Yes Noise - No Ionizing/Non-Ionizing Radiation - No Infectious Diseases - Yes
$17.67 - $28.19 Overview
Located in the heart of Washington, we enjoy open skies, snow-capped mountains, and the lakes and rivers of the high desert. We are the proud home of orchards, farms, and small communities. Confluence Health actively supports the communities we serve and their quality of life through our community support program and through our individual efforts as involved community members.
Employees of Confluence Health receive a wide range of benefits in addition to compensation.
Medical, Dental & Vision Insurance Flexible Spending Accounts & Health Saving Accounts CH Wellness Program Paid Time Off Generous Retirement Plans Life Insurance Long-Term Disability Gym Membership Discount Tuition Reimbursement Employee Assistance Program Adoption Assistance Shift Differential For more information on our Benefits & Perks, click here!
Summary
The Outpatient Authorizations Specialist II is responsible for determining when an authorization is required for healthcare services and for submitting prior authorization requests in accordance with health plan requirements. Documents all authorization information and determinations in the patient's electronic medical record. Proper execution of this work directly impacts revenue for the organization and supports its denial management and prevention strategies.
Position Reports To:
Authorizations Manager
Essential Functions
Researches prior authorization requirements and submits prior authorization requests in a timely manner. Researches, recognizes, requests, and submits the clinical documentation required to support the medical necessity of the service being authorized. Properly documents all authorization requests and decisions in the patient's auth/cert or referral record utilizing standard EPIC workflows and work queues. Accurately interprets medical policies and how they pertain to services being authorized. Utilizes payor tools and websites as needed to facilitate prior authorization requests. Verifies insurance eligibility and benefits and updates patient insurance information as needed. Reviews and resolves all reported authorization issues. Proactively researches and stays informed of changing insurance pre-authorization requirements and health plan updates. Communicates with providers, Staff, and Patients to keep them apprised of the status of the authorization requests and processes denied authorizations in a timely manner. Keeps pace with workflow by remaining up to date on work and preventing backlog in workflows. Collaborates with teammates and leadership to identify process improvements and optimizations. Advises leadership of payor trends and issues. Develops and maintains positive rapport with both internal and external customers. Participates in team huddles, meetings, and trainings as required by leadership to maintain collaboration, continuing education, and team synergy. Collaborate with other SME's, Outpatient Authorizations Lead and the Outpatient Authorization Manager to establish best practice standards. Continually improve work process to enhance service and customer relations. Investigate authorization denials and assists with appeals. Troubleshoot escalated requests from staff and providers and problem solves for difficult and unusual authorizations and referrals. Assists in problem identification, quantification, and resolution. Provide education and communication to providers and staff regarding prior authorization requirements by payor and procedure/service. Performs other duties as assigned.
Demonstrate Standards of Behavior and adhere to the Code of Conduct in all aspects of job performance at all times.
Qualifications
Required:
High School Diploma or equivalent. Demonstrated experience with insurance requirements for referrals and/or prior authorizations to various therapies, surgeries, procedures, diagnostic testing, etc. Experience investigating denials. Possesses intermediate computer skills (e.g., spreadsheets, word processing); knowledge of MS Office. Effective written and verbal communication skills. Effective reading comprehension skills. Demonstrated customer service experience in an office or clinical setting. Ability to multi-task and thrive in a dynamic and fast-paced environment. Ability to prioritize workload and meet deadlines while being flexible to the changing demands of coverage. EHR proficiency. 2 years working in a healthcare setting as an Authorization Specialist or a certification/credential in one of the following: AAHAM - CRCS; AAPC - CPC; or MA-C. Desired:
Associates degree. Experience in CPT/ICD-10 coding. EPIC experience in Prelude, Cadence, Grand Central, and/or Resolute applications. Physical/Sensory Demands
O = Occasional, represents 1 to 25% or up to 30 minutes in a 2 hour workday. F = Frequent, represents 26 to 50% or up to 1 hour of a 2 hour workday. C = Continuous, represents 51% to 100% or up to 2 hours of a 2 hour workday.
Physical/Sensory Demands For This Position:
Walking - F Sitting/Standing - C Reaching: Shoulder height - F Reaching: Above shoulder height - O Reaching: Below shoulder height - F Climbing - O Pulling/Pushing: 25 pounds or less - O Pulling/Pushing: 25 pounds to 50 pounds - O Pulling/Pushing: Over 50 pounds - O Lifting: 25 pounds or less - F Lifting: 25 pounds to 50 pounds - O Lifting: Over 50 pounds - O Carrying: 25 pounds or less - O Carrying: 25 pounds to 50 pounds - O Carrying: Over 50 pounds - O Crawling/Kneeling - O Bending/Stooping/Crouching - F Twisting/Turning - F Repetitive Movement - C Working Conditions:
Normal office environment which consists of sitting at a desk for long periods of time, talking on a telephone, working on a computer, and processing paperwork. The office environment may consist of clinical office, business office, or home office depending on need. Job Classification:
FLSA : Non-exempt Hourly/Salary : Hourly Physical Exposures For This Position:
Unprotected Heights - No Heat - No Cold - No Mechanical Hazards - No Hazardous Substances - No Blood Borne Pathogens Exposure Potential - Yes Lighting - Yes Noise - No Ionizing/Non-Ionizing Radiation - No Infectious Diseases - Yes