Authorization Specialist

Authorization Specialist Position Summary

The Authorization Specialist is responsible and accountable for monitoring and submitting all insurance authorizations including but not limited to prior service, surgical, acute hospital, and post-acute care authorizations that may include rehabilitation, transportation, medication, durable medical equipment, and home service authorizations that align with medical necessity policies and regulatory requirements for Tidal Health. The Authorization Specialist works collaboratively with Case Managers, Utilization RNs, physician advisors, insurance companies, finance, patients, providers, and authorization process stakeholders, to reduce length of stay, ensure fiscal responsibility, appropriate use of benefits, and streamline the discharge process.

They will also be responsible for maintaining and following up on non-clinical administrative tasks related to utilization review, discharge planning, PCP appointments, regulatory paperwork, invoicing, prior authorizations, benefit verification preservice review, healthcare claims inquiry, appeal/denial tracking, and case documentation.

Education:

• Bachelor’s degree in a health-related field or equivalent medical office experience is required.

Experience:

• Minimum of three (3) years clinical/medical office and/or related experience required.
• Working knowledge of Microsoft applications, primarily Excel, Outlook and Word is required.
• Working knowledge of ICD Diagnostic Codes and medical terminology.

Schedule:

• Primarily day shift, Monday through Friday