Advance Authorization Specialist
Company: Atrium Health
Location: Charlotte
Posted on: October 24, 2024
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Job Description:
Overview
Primary Purpose
The Advanced Authorization Specialist is responsible for all
aspects involved in obtaining highly complex authorizations for a
multitude of In-patient and Out-patient Services. The Advanced
Authorization Specialist must be knowledgeable and have a thorough
understanding of Commercial and Government payors with regards to
Coordination of Benefits, Authorization guidelines, Pharmacy and
Medical Benefit variances, as well as Medical Necessity Policies.
The Advanced Authorization Specialist is responsible for reading
and interpreting various complex medical records to obtain
authorizations for requested services and treatment plans.
Communication with clinic staff, providers, Pharmacists, and
insurance companies is essential to ensure completed peer reviews,
relay updated medical and specialty drug policies, and appeals.
They work closely with the Hospital and Provider Denial Management
Teams to review monthly denials and assess opportunities for
retro-active authorizations and determine root cause analysis.
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Major Responsibilities -
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Minimum Job Requirements
Education
Bachelor's Degree or 3 years of authorization experience
required.
Work Experience
Bachelor's Degree or 3 years of authorization experience
required.
Knowledge / Skills / Abilities
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Physical Requirements and Working Conditions
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DISCLAIMER
All responsibilities and requirements are subject to possible
modification to reasonably accommodate individuals with
disabilities.
This job description in no way states or implies that these are the
only responsibilities to be performed by an employee occupying this
job or position. - Employees must follow any other job-related
instructions and perform any other job-related duties requested by
their leaders.
Keywords: Atrium Health, Rock Hill , Advance Authorization Specialist, Other , Charlotte, South Carolina
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