Authorization Specialist in Henderson, NC at Maria Parham Health

Date Posted: 12/2/2019

Job Snapshot

Job Description

Maria Parham Health

Under the general direction of the department director, the Central Scheduling Specialist will primarily be responsible for scheduling medical procedures for prospective patients by coordinating all aspects of the scheduling cycle. This will initially include order intake via phone queue and fax as well as insurance benefit verification. Additionally, the position requires an ability to handle clinical assessment and insurance authorizations that are necessary preconditions for qualifying patients both medically and financially for final appointment confirmation. This position will also involve a basic understanding of insurance material such as claims, denial resolution, and appeals as needed. This position reflects a “help desk” approach to scheduling by actively responding to the general needs of the ordering physician’s and their patients.

Requires excellence in customer service and telephone etiquette. Must be able to participate in receiving phone calls via a department telephone queue.

2.  Uses clinical knowledge to receive orders for review and clarification when needed, including medical necessity checking for all Medicare patients.

3.  Must show a basic facility with insurance benefits, coverage verification, network access, coordination of benefits (COB), payment calculation, and referral requirements.

4.  Must be able to calculate total cost and payment options for each requested service and effectively communicate with patients about their options.

5.  Must be able to integrate a variety of clinical data, assess, and conduct medical necessity reviews with appointed utilization review departments. This will include exchanging clinical information with registered nurses and physicians and negotiating the best possible outcome or alternative modality.

6.  Communicates all exam prep information directly to the patient including directions and registration arrival times to the facility and ancillary departments.

7.  Must show a strong attention to detail including an ability to transfer patient data in a reliable and consistent manner within regulatory guidelines.

8.  This position will work interdepartmentally in providing critical support toward maximizing upfront collections and patient throughput while minimizing patient delays, rescheduling, and cancelations.

9.  Identifies patients who qualify for alternative financing options and assists with any necessary arrangements toward completing their registration.

10.  Must show an ability to work in a culturally diverse work environment and display a sensitive approach toward those with learning disabilities or other communication challenges.


Job Requirements

1. 2-4 years’ experience in a medical environment (hospital ancillary department, doctor’s office, x-ray lab), preferably with additional exposure to a related field such as registration, claims and patient financial services, or other ancillary department experience, etc. A broad employment history in these settings will be most helpful.

2. This position requires a High school graduate or GED.  Additionally, an Associate or Bachelor’s degree or the equivalent combination of experience and training is preferred. Customer relations experience is a plus.  Requires demonstrated ability to evaluate a patient’s medical history via chart notes or other clinical source and accurately apply it to commercial insurance utilization criteria.


Equal opportunity and affirmative action employers and are looking for diversity in candidates for employment: Minority/Female/Disabled/Protected Veteran