Authorization Specialist

Tufts Medicine - Lawrence, MA

Full-time - Entry Level

Hybrid - Lawrence, MA

Ambulatory Health Care Services

About the position

The Authorization Specialist role at Tufts Medicine focuses on revenue cycle operations, specifically in Patient Access duties. This position is responsible for administrative and financial-clearance tasks that facilitate the procurement of clinical services for patients. The role involves collecting necessary demographic and financial information, scheduling services, and ensuring pre-certification from applicable payers. It is an entry-level position that requires strong organizational skills and the ability to work under supervision while providing support in a hands-on environment.

Responsibilities

• Contact insurance companies and workers compensation carriers to obtain verification of insurance, eligibility, and level of benefits.
• Enter benefit information into the hospital electronic medical record system.
• Contact patients for updates of financial and demographic information and ensure timely updates in EMR.
• Obtain financial data from various sources including in-state and out-of-state payers.
• Arrange for coordination of benefits when multiple insurance carriers are involved.
• Seek administrative approval of admission (precertification) for surgeries, admissions, procedures, imaging, and other services by providing clinical data to payers.
• Identify procedures and services that are not covered by individual insurance policies.
• Communicate financial risk concerns to the ordering department and Patient Access leadership.
• Collaborate with Financial Coordination and Pre-Registration colleagues regarding patients with identified financial risk concerns.
• Obtain applicable clinical documentation required by insurance payers for elective services and submit in a timely manner.
• Follow case statuses and document pending and approved statuses in the hospital system.
• Identify denied claims and work with department leaders toward their appeal and peer-to-peer workflow.
• Monitor productivity and quality of workflow, reaching productivity and quality review goals.
• Act as a resource to other departments regarding precertification policies and resolution of accounts.
• Maintain collaborative relationships with peers to contribute to the working group's goals.
• Work closely with Case Management and Admitting colleagues to confirm level of care changes and communicate with payers.
• Learn and adapt to new workflow changes and assist in training new team members.

Requirements

• High school diploma or equivalent.
• Three (3) years of related experience in a hospital, physician office, or financial services.

Nice-to-haves

• Associate's degree.
• Five (5) years of related experience in a hospital, physician office, or financial services.

Benefits

• Hybrid working model
• Full-time hours
• Onsite training provided