Authorization Specialist

Job not on LinkedIn

🔥 2 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

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Lehigh Valley Health Network

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Lehigh Valley Health Network is a comprehensive healthcare system that is now part of Jefferson Health, one of the top 15 not-for-profit health systems in the United States. It offers a wide range of medical services, including primary care, urgent care, and specialized institutes like the Lehigh Valley Topper Cancer Institute and the Lehigh Valley Heart and Vascular Institute. LVHN provides extensive care solutions, including video visits, second opinions, and a network of doctors and clinicians in numerous locations. It emphasizes education through residencies and fellowships and prioritizes patient-centric services such as lab testing and women's health care. The network also focuses on innovation, offering clinical trials and advanced therapies like CAR-T Cell Therapy.

📋 Description

• Obtain benefits and authorizations for surgical procedures, diagnostic testing, medications, outgoing referrals, and other services • Determine authorization protocols for each health plan • Perform billing duties to ensure proper and timely payment from insurance carriers and patients • Collaborate with physicians and provider office staff to ascertain appropriate authorization based on medical necessity and treatment plans • Perform medical necessity checks to determine whether procedure and diagnosis support medical necessity • Ensure authorizations comply with network policy and communicate exceptions to the ordering office, patient, and manager • Communicate with insurance companies to obtain insurance verification, benefits, and precertification approvals • Verify additional clinical information and insurance authorizations/referrals • Review and monitor WQs/schedules to ensure proper and accurate authorization before patient visits • Maintain compliance with benchmark data regarding accounts registered versus scheduled procedures • Determine estimated patient financial responsibility using insurance verification information, payer contracts, and/or self-pay guidelines

🎯 Requirements

• High School Diploma/GED with specialized training in insurance, coding, billing, or similar healthcare certificate programs • 1 year in a healthcare setting with insurance verification/authorizations • Familiarity with billing procedures and payer reimbursement • Knowledge of patient rights and laws relative to those rights, such as HIPAA • Proficient in utilization management processes, standards, and managed care • Proficient in standard medical practices and insurance benefit structures • Ability to lift and carry 25 lbs. • Frequent sitting/standing and keyboard use

🏖️ Benefits

• Full-time employment • Day shift schedule • Monday-Friday, 8:00a-4:30p work schedule