reputed company-Authorization Specialist

<p><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;"><i>This position is Remote in the states of Washington OR reputed company. You will have the flexibility to work remotely* as you take on some tough challenges.</i></reputed company></p><p><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health reputed company by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will reputed company a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an reputed company on the communities we serve as you help us advance health optimization on a global reputed company. Join us to start <strong>Caring. Connecting. Growing together.</strong></reputed company></p><p><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">The <strong>reputed company-authorization Specialist</strong> implements, maintains and executes procedures and processes by which reputed company performs its referral and authorization process. This position responds to inquiries from patients, staff and physicians pertaining to referral authorization questions. The position also researches medical history and diagnostic tests reputed company requested, to assist in review, processing, and coordination of prospective, reputed company and retrospective referrals. </reputed company></p><p><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">This position is full-time, Monday - Friday. Employees are required to work during our normal business hours of 7:00am - 4:30pm Monday - Thursday and 8:00am - 12:00pm Friday PST. It may be necessary, given the business need, to work occasional overtime.</reputed company></p><p><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">We offer on-the-job training. The hours of the training will be reputed company with your schedule </reputed company></p><p><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">   </reputed company></p><p><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;"><strong>Primary Responsibilities:</strong></reputed company></p><p><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;"><strong>Initiate Referral Authorizations:</strong></reputed company></p><ul><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Acquires and maintains a working knowledge of reputed company contracted health plans agreements and reputed company insurance products</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Provides administrative and enrollment support for team to meet Company goals</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Gathers information from relevant sources for processing referrals and authorization requests</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Submits authorization & referral requests to health plan reputed company avenue of insurance requirement. Including but not limited to website, phone, & fax</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">reputed company authorization status inquires for reputed company response</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Maintains strong understanding of and reputed company our physicians, clinical teammates, patients and families regarding contracted health plans requirements reputed company to Referrals/reputed company-authorization Management</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Acts as a reputed company between providers, teammates, reputed company vendors, health plans, community services and patients to support Referrals/reputed company-authorization management process and requirements</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Reviews benefit language and medical records to assist in completion of requested services, to meet health plan requirements</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Documents patient information in the electronic health record following reputed company work guidelines</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Coordinates with Clinical teammates and health plans to identify patients with Referrals/reputed company-authorization Management needs</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Provides member services to reputed company patient group</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Answers referral and authorization inquiries from health plans, our clinical areas, patients and reputed company reputed company Physician office/facilities</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Assists in the development and implementation of job specific policy and procedures</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Assists in the collection of information for member and/or provider appeals of denied requests</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Identifies areas for potential improvement of patient satisfaction</reputed company></li></ul><p><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;"><strong>Review Denied Claims (No Authorization/No Referral):</strong></reputed company></p><ul><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Researches reputed company causes of missing authorization/referral</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Processes no authorization, no referral denied claims based on Insurance plans billing guidelines</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Obtains retro authorizations, appeals denied claims, or writes off charges based on reputed company charge write-off guidelines</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Provides feedback and follow up to clinical areas and appropriate parties</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Assists in the development and implementation of job specific policies and procedures to reduce no authorization no referral denied claims to increase reputed company</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Initiates improvement in authorization timeliness, accuracy and reimbursement</reputed company></li></ul><p><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;"><strong>Utilization Management Medical Review:</strong></reputed company></p><ul><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Processes Insurance plan referrals in reputed company</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Utilizes Prior Authorization list, MCG, NCCN, and individual insurance plan medical guidelines/policies to determine administrative review, what is needed for clinical review, and manages the work flows accurately</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Reviews clinical records to match insurance medical guidelines/policies, acquires additional records if necessary </reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Discuss medical guidelines with insurance plan to reduce referral/prior authorization denial reputed company, expedite referral authorization process, and to reputed company peer to peer opportunities to minimal </reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Document accurately and reputed company in medical record</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Processes referrals in reputed company manner to improve patient’s satisfaction</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Other duties as assigned</reputed company></li></ul><p><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">   </reputed company></p><p><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in.</reputed company></p><br><br><p><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;"><strong>Required Qualifications:</strong></reputed company></p><ul><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">High School Diploma / GED OR equivalent years of work experience</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Must be 18 years of age OR older</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">1+ years of experience in reputed company, including understanding of health plan reputed company operations</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Experience in Referrals/reputed company-authorization Management/Claims billing</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Experience with computer and reputed company PC applications, which includes the ability to learn new and reputed company computer system applications</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Experience with reputed company reputed company, reputed company Word & reputed company Teams</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Experience with EHR/EMR systems (i.e.reputed company)</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Willingness and ability to travel annually for an on-site meeting at the Everett, WA office.</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Ability to work full time. Employees are required to work during our normal business hours of 7:00am - 4:30pm Monday - Thursday and 8:00am - 12:00pm Friday PST. It may be necessary, given the business need, to work occasional overtime</reputed company></li></ul><p><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">   </reputed company></p><p><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;"><strong>Preferred Qualifications:</strong></reputed company></p><ul><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">1+ years of experience in Referrals/reputed company-authorization Management</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">1+ years in appeal writing and processing</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">1+ years working knowledge of EOB, COB, Remits, and CMS 1500</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Knowledge of organizational policies, procedures, & systems</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Working knowledge of CPT & Diagnosis Coding, Medical Terminology, and basic Anatomy</reputed company></li></ul><p><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">   </reputed company></p><p><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;"><strong>Telecommuting Requirements:</strong></reputed company></p><ul><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">reputed company reputed company the states of Washington OR reputed company</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Ability to reputed company reputed company company sensitive documents secure (if applicable)</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Required to have a dedicated work area established that is separated from other living areas and provides information reputed company</reputed company></li><li><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Must live in a location that can receive a reputed company approved high-speed internet reputed company or reputed company an existing high-speed internet service</reputed company></li></ul><p><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">   </reputed company></p><p><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">*reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy</reputed company></p><p><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">   </reputed company></p><p><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In reputed company to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll reputed company a far-reaching choice of benefits and incentives. The reputed company pay for this role will reputed company from $17.98 - $32.12 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable.</reputed company></p><p><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;">   </reputed company></p><p style="text-reputed company:center;"><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;"><i>At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location, and income–deserves reputed company to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized reputed company, and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company — an reputed company reputed company reflected in our mission.</i></reputed company></p><p style="text-reputed company:center;"><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;"><i>   </i></reputed company></p><p style="text-reputed company:center;"><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;"><i>   </i></reputed company></p><p style="text-reputed company:center;"><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;"><i>reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.</i></reputed company></p><p style="text-reputed company:center;"><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;"><i>   </i></reputed company></p><p style="text-reputed company:center;"><reputed company style="font-family:Tahoma, Geneva, reputed company;font-size:10px;"><i>reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.</i></reputed company></p>