Authorization Specialist

Job Summary

The Prior Authorization Specialist  plays an integral role in optimizing the plan of care for Managed Care patients. They are responsible for the timely compilation, review and submission of medical information relating to the post-acute skilled stay. By serving as the liaison between the patient, physician, interdisciplinary care team members, and the payer; this position coordinates, monitors, advocates and communicates the patients progress and cost evaluation while assisting with and coordinating an efficient and smooth discharge.

Responsibilities

• Maintains a strong working knowledge of all managed care contracts for their assigned area of responsibility.
• Negotiates appropriate levels of care for contracted and non-contracted terms with the payor case manager.
• Communicates information to care team and coordinates patient's smooth transition to the next level of care.
• Obtains accurate information from physicians, patient, and payor source regarding the expected discharge plan and communicates this information to the interdisciplinary team
• Complies with key department expectations for care coordination and utilization 
• Models customer service principles and promotes appreciation of our internal and external customers’ needs.
• Knows, understands, and models Legacy Health Services mission and service principles.
• Communicates customer objectives and expectations to other team members involved with the accounts.
• Establishes realistic expectations for service levels with referral sources and market contacts.
• Ensures protected health information is kept confidential.

Education and Experience

• Licensed clinical degree preferred or bachelor’s degree in healthcare or related field. Current, active, and unrestricted licensure or certification in health or human services discipline preferred.
•  2+ years of experience working in a health care setting or health care role with a minimum of 1 year of Case Management experience preferred.
• Comprehensive knowledge of worker’s compensation, insurance, and managed care, required.
• Prior experience with an insurance company, private case management or MCO preferred. Familiarity with long term care and/or sub-acute care useful. 
• Exceptional verbal and written interpersonal and communication skills required. 
• Must be detail oriented and possess strong problem solving, conflict resolution and negotiating skills.
  Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.
• Proficient with computer skills including Microsoft Office applications including Word,
  Excel, and PowerPoint.