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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
