Authorization Specialist

The Authorization Specialist is responsible for all administrative processing regarding prior authorizations, referrals, and appeals for a group of dialysis clinics. This individual cooperates and works closely with both in person and remote co-workers, possesses strong time management skills and the ability to complete assigned job duties with applicable supervisory direction including exercising job appropriate judgement.

Essential Functions:
1. Initiates prior authorizations and referrals— via phone, fax, and/or email, based on patient specific insurance benefits to ensure coverage and payment for dialysis services.
2. Tracks and follows up with payers timely to ensure resolution to open requests.
3. Works with clinic staff and patients to gather supporting information for authorization requests.
4. Establishes and maintains professional relationships with payer Utilization Management contacts as appropriate.
5. Coordinates with clinic staff and other admissions department staff to ensure timely acceptance into the clinic.
6. Verifies accuracy of authorization responses from payers against expected or billed services.
7. Enters and updates authorization information into various systems for billing and auditing purposes.
8. Acts as first point of contact for patient or clinic staff questions related to authorizations and referrals. Escalates difficult conversations as necessary.
9. Completes and maintains region and clinic specific reports related to authorizations and referrals.
10. Maintains authorizations for existing patients and proactively initiates renewal requests to ensure no lapses in authorized coverage.
11. Initiates admission for transfer patients from the hospital, by confirming discharge and applicable documentation.
12. Ensures confidentiality of all data, including patient, employee, and operational data.
13. Adapts and is flexible when change arises, alternating between tasks as needed.
14. Stays current with department changes and updates and willingly learns new skills.
15. Handles patient information with discretion and maintains HIPAA compliance.
16. Understands and complies with Medicare rules and regulations, as well as applicable federal, state, agency, region and clinic rules and regulations.
17. Performs other tasks, duties and projects as assigned.

Position Type, Expected Hours of Work & Travel:
This is a Full-Time position. Days and hours of work are Monday through Friday, between the hours of 8:00 a.m. and 5:00 p.m. Hours are based on regions supported. Travel is not expected with this position.

Required Education and Experience:
-Bachelor’s degree required. Focus in business or healthcare management preferred.
-0-2 years of experience in similar administrative setting. Combination of degree and work experience will be considered.
-Bilingual in Spanish is helpful, but not required.
-Excellent customer service skills, oral and written communication skills, and ability to actively contribute as a team player with superior attention to detail required.
-Ability to multi-task and work in a fast-paced environment while meeting deadlines and maintaining high standards of accuracy required.
-Proficiency in Microsoft Office Suite required.

Equal Opportunity Employer:  
Innovative Renal Care is an equal opportunity employer and a drug free workplace.  All qualified We applicants will receive consideration for employment without regards to race, color, religion, sex, sexual orientation, gender identity, national origin, citizenship, disability, or protected veteran status.  

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