Job Summary
The Authorization Specialist is responsible for ensuring that payers are prepared to reimburse Riverview Health for scheduled services in accordance with the payer-provider contract. The Specialist contacts payers to request service authorization and may collect clinical, financial and/or demographic information from clinics, hospital departments and/or patients as needed.
Job Responsibilities
- Verifies patients’ insurance and benefits information
- Obtains prior authorizations from third-party payers in accordance with payer requirements. Identifies patients who will need to receive Medicare Advance Beneficiary Notices of Noncoverage (ABNs).
- Contacts patients to gather demographic and insurance information as needed, and updates patient information within the EMR as necessary.
- Works with other departments to gather the clinical information required by the payer to authorize services. Maintains accurate records of authorizations within EMR.
- Develops price estimates for patient out-of-pocket responsibility.
- Refers accounts to financial counseling as needed if authorization is not obtained. Works with business office staff to support appeal efforts for authorization-related denials.
- Reviews surgery schedules to ensure Medicare patients with IP-only procedures have the appropriate authorization and order.
- Complies with HIPAA regulations, as well as Riverview Health policies and procedures regarding patient privacy and confidentiality.
- Maintains professional tone at all times when communicating with patients and payer representatives.
- Coordinates re-education to practices or hospital departments when orders are incorrect or not supported by the given diagnosis.
- Performs other duties as requested.
Education Requirements
- Minimum: Associate degree in healthcare or business administration and/or related coursework, or comparable experience
- Preferred: Experience in Epic
Experience Requirements
- Minimum: Two years of experience in a healthcare setting performing related tasks
- Preferred: Five years of experience in a healthcare setting performing related tasks
License/Certification Requirements
- None
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Skills Required
- Associate degree in healthcare or business administration or comparable experience
- Two years of experience in a healthcare setting performing related tasks
- Experience in Epic
- Five years of experience in a healthcare setting performing related tasks
What We Do
Riverview Health is comprised of a full-service, 156-bed hospital in Noblesville, a 16-bed hospital in Westfield, as well as freestanding combined ER and urgent care facilities. Also included are more than 25 primary, immediate and specialty-care facilities in Hamilton County. Riverview Health provides comprehensive inpatient and outpatient services in more than 35 healthcare specialties and has been frequently recognized for its clinical and service excellence, including being named America's 100 Best Hospitals for Orthopedic Surgery by Healthgrades and earning the Healthgrades Outstanding Patient Experience award. For more information on Riverview Health, visit riverview.org.Together, we provide comprehensive inpatient and outpatient services in more than 35 healthcare specialties—and have been frequently recognized for our clinical and service excellence. A wide range of services is provided at our main campus—located at 395 Westfield Rd. in Noblesville—including comprehensive care in heart & vascular, orthopedics, advanced emergency services and a vast array of women's health services. As one of the largest employers in Hamilton County, Riverview Health employs more than 1,400 employees, thereby having a significant impact on the local economy. Riverview Health is owned by the county and does not receive tax dollars for operating expenses.
