Authorization Specialist

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Job Overview

The Authorization Specialist position is offered by Lehigh Valley Health Network, widely recognized as a leading organization in the healthcare industry. This role emphasizes the importance of obtaining authorizations and benefits for various medical services, ensuring the financial integrity of healthcare processes and a positive patient experience. The position is remote, allowing employees to work from their chosen locations within Pennsylvania. The work schedule is primarily Monday to Friday from 8:00 AM to 4:30 PM.

Key Responsibilities

As an Authorization Specialist, your core duties will include:

1. Obtaining Authorizations: You will work diligently to secure authorizations needed for surgical procedures, diagnostic testing, medications, and outgoing referrals, crucial in maintaining the flow of patient care.

2. Collaboration: The role involves close collaboration with physicians and provider office staff to ascertain appropriate authorizations based on medical necessity and established treatment plans. A significant part of your job will include communicating with various insurance companies to secure insurance verification and precertification.

3. Billing Duties: You will be responsible for billing functions that ensure proper and timely payments are secured from insurance carriers and patients. This part of the job requires understanding billing procedures and payer reimbursements, which are vital for the financial operations of the health network.

4. Compliance: You'll maintain compliance with benchmark data regarding patient accounts. Monitoring and verifying workflows will be part of your ongoing daily responsibilities, ensuring authorizations and procedures align with the organization's policies.

5. Medical Necessity Reviews: Part of your role includes performing medical necessity checks to confirm that procedures align with clinical insights and established guidelines. If discrepancies arise, communicating with the appropriate parties is imperative.

Required Skills and Qualifications

To qualify for the Authorization Specialist role, applicants should meet the following criteria:

• Education: A minimum of a High School Diploma or GED is necessary, along with specialized training in insurance, coding, billing, or related healthcare certificate programs.

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• Experience: At least one year of experience working within a healthcare setting, particularly focused on insurance verification and authorizations, is required. Previous interactions with patients and healthcare providers will be highly advantageous.

• Knowledge: Familiarity with billing procedures and payer reimbursements is crucial. Knowledge of patient rights, particularly in relation to HIPAA, is also important. Proficiency in medical practices and understanding of insurance benefit structures is valued.

• Physical Demands: Candidates should be capable of lifting and carrying weights up to 25 lbs and exhibit proficient keyboard usage. Those in patient care roles may need to perform actions such as kneeling, bending, and performing CPR.

Preferred Qualifications

Having an Associate’s Degree may be beneficial and add value to candidates, enhancing their employability in this role.

Employment Conditions

The role is categorized as full-time and provides flexibility through remote work. It emphasizes the commitment of Lehigh Valley Health Network to provide an inclusive workplace, adhering to equal opportunity employment standards. Benefits can be assumed but are not outlined within the provided text. The company is known for its accolades in patient safety and quality care, aligning with their ​reputation as one of the best hospitals in the nation for numerous consecutive years.

Why Choose Lehigh Valley Health Network?

Choosing to work at Lehigh Valley Health Network means joining a dedicated team that prioritizes innovation, teamwork, and consistently high-quality care. Employees benefit from a professional environment that promotes growth and learning opportunities. The acknowledgment of their hospitals places them on a pedestal as experienced healthcare providers committed to offering exceptional health care experiences.

Overall, being an Authorization Specialist at Lehigh Valley Health Network signifies becoming part of a reputable institution making significant health care advancements. Job seekers who prioritize a community of excellence and professional growth should strongly consider this opportunity.

This job offer was originally published on himalayas.app