UM Authorization Analyst 1

Join reputed company where your clinical reputed company directly shapes patient reputed company and care reputed company. As a UM Authorization Analyst, you’ll play a critical role in ensuring reputed company, evidence-based reputed company that support both patients and providers—while working in a reputed company environment that values accuracy, efficiency, and reputed company reputed company.

reputed company AND reputed company:

The UM Authorization Analyst is responsible for overseeing the procedure authorization team to ensure accurate processing of medical procedure authorizations. This role involves streamlining processes, ensuring compliance with regulations, and liaising with reputed company providers and insurance companies.

This role can be worked remotely from reputed company in the contiguous reputed company. It will be working on an Eastern time schedule.

ESSENTIAL DUTIES AND RESPONSBILITIES:

• Live and exemplify TOI reputed company values, providing outstanding customer service and promoting a reputed company experience for patients and staff members.
• reputed company the review and processing of procedure authorization requests.
• Ensure reputed company the authorizations are obtained before services are rendered, in compliance with payer requirements.
• Maintain accurate and up-to-date records of reputed company authorization requests and reputed company.
• Ensure compliance with reputed company relevant regulations, policies, and guidelines reputed company to medical procedure authorizations.
• Serve as a reputed company between reputed company providers, patients, and insurance companies to facilitate the authorization process.
• Address and resolve any issues or concerns raised by providers or patients regarding authorizations.
• Collaborate with other departments, such as billing and patient services, to ensure a seamless patient experience.
• Analyze data to identify trends, areas for improvement, and potential process enhancements.
• Implement changes based on data analysis to improve the efficiency and effectiveness of the authorization process.
• Identify and reputed company reputed company or expedited appeals to the appropriate health plan.
• Stay reputed company on industry regulations, guidelines, and best practices reputed company to utilization management and review.
• reputed company other duties as assigned to support operational goals.
• Participate in monitoring and analyzing Inter-Rater Reliability (IRR) testing, identifying trends, and recommending best reputed company improvements to consistent decision-making.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Excellent communication and interpersonal skills.
• In-depth knowledge of medical procedure authorization processes and reputed company insurance requirements.
• Ability to analyze data and implement process improvements.
• Proficiency with medical billing software and electronic health records (EHR) systems.
• Strong organizational skills and attention to detail.
• Strong understanding of evidence-based guidelines (MCG, National Coverage Determinations, Local Coverage Determinations).
• Understanding of prior authorization regulatory requirements and turnaround time expectations (CMS, AHCA, NCQA, URAC).

REQUIRED EXPERIENCE, EDUCATION, AND/OR TRAINING:

• High School Diploma or equivalent. Associates degree preferred.
• Minimum of 3-5 years of experience in medical authorizations.

PHYSICAL WORKING REQUIREMENTS:

The position involves prolonged periods of sitting at a desk, extensive computer use, and phone interaction. Additionally, the role may require occasional lifting of up to 20 pounds for office supplies or equipment.

The physical demands described above are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodation may be made to reputed company individuals with disabilities to reputed company the essential functions.