Job Description:
Coordinate the authorization process and support the Health Resources Management Department (HRM).
Job Responsibilities
- Complete authorization requests in accordance to the operational procedures outlined within the HRM Operations Manual and Policy Provisions.
- Researching and troubleshooting complex authorization rules to render the correct decision based on members’ benefits, a Health Plans’ contractual arrangements, and specific criteria to determine if service may be authorized.
- Enter authorization data into Epic database using correct types and codes.
- Answer phone queue line calls in accordance with departmental standards.
- Monitor Customer Service Requests (CSR) activity; respond appropriately within department standards.
Additional Responsibilities
- Serve as resource for customer service.
- Maintain open lines of communication within all departments of the organization.
Required Experience
- Medical Assistant certification and/or 1-3 years of Healthcare experience preferred
- Strong knowledge of medical terminology
- Working knowledge of CPT/ICD10 & HCPCS codes
- Accurate data entry and Microsoft Office skills (intermediate).
- Strong verbal communication, decision-making and problem solving skills
- Strong organizational skills and detail oriented
- Ability to work independently and as part of a team
- Able to multi-task and work in a productivity-based environment
- Epic/Tapestry experience is a plus
Required Education
H.S. Diploma or GED
Additional Information
Salary: $108,000 - $138,000 Annual
