Outpatient Authorization Specialist

Summary

The Authorization Specialist is responsible for facilitating and successfully procuring outpatient insurance authorizations. The Authorization Specialist will be accountable to one or more designated service lines across all sites of service to ensure payor requirements are met and authorizations are obtained timely and appropriately prior to service. The Authorization Specialist will provide subject matter expertise in the payor authorization process, identify changes in payor authorization requirements and communicate areas of opportunity for process improvement from a workflow and technology perspective to the leadership team.

Mission Statement

Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.

Responsibilities*

• Complete all aspects of the insurance pre-authorization process within required timeframes.

• Apply appropriate CPT codes for planned outpatient services and provide codes and clinical documentation to payors utilizing payor specific communication protocols.

• Prioritize and procure all required authorizations prior to service reducing appointment cancelations and reschedules due to no authorization.

• Act as a subject matter expert in insurance authorization requirements and timeframes including but not limited to in office procedures, in office medication/injections, diagnostic testing and external high-end imaging requests.

• Act as a referral coordinator and central resource/liaison for the assigned specialties across all sites of service, ordering providers and insurers.

• Verifies insurance coverage and identifies patient financial liability

• Provide timely communication to the authorization team and leadership regarding changes in payor requests or requirements that directly impact the procurement of authorization.

• Assist in the coordination of peer-to-peer reviews between the servicing provider and medical directors at the insurance company when appropriate.

• Clearly and thoroughly document all actions, payor and patient contacts, authorization outcomes and interventions following standardized workflow processes.

• Respond and address insurance related questions from Michigan Medicine customers and patients promptly and thoroughly.

• Obtain retro authorizations on billed and rejected claims and denied procedure codes for facility and professional services. Initiate appropriate follow-up actions in response to information obtained and document outcomes.

• Refer patients with complex insurance concerns requiring immediate attention to the Patient Financial Clearance or Financial Counselor or alternate funding sources as needed.

• May act as a resource to mentor and educate new hires.

• Attend and participate in operational meetings, utilizing LEAN thinking and principles. Work collaboratively with the team to develop standardized processes and incorporate efficiencies into daily workflow.

• Assist and contribute to the overall achievement of the Michigan Medicine and PreService Revenue Cycle quality, operational and financial goals and objectives.

Required Qualifications*

• High school diploma in combination with 2-3 years' experience working with health insurance or in a healthcare setting is essential.

• Outstanding customer service, written and verbal communication skills are mandatory.

• Ability to prioritize and handle multiple tasks, producing high-quality work in a timely, accurate and efficient manner is required.

• Proficiency in the use of computers and basic software applications is necessary.

• Ability to be flexible and work within a team-focused, participative management framework is required.

Desired Qualifications*

• An Associate's Degree with two years of progressively complex healthcare registration, medical or surgical specialty clinic and/or insurance experience is preferred.

• Understanding and knowledge of insurance benefits, third party payor rules and regulations is preferred.

• Familiarity with medical terminology, ICD-10 and CPT codes is desired.

• Experience working in the EPIC system is desired.

Work Locations

Remote Job Requirements:

This position is a remote position where you will work from home/virtually once training is completed and performance-based competency has been obtained. High speed internet is a requirement for this position and the cost is the responsibility of the staff member. There may be occasions where the staff member may need to report to the business office location, including meetings, computer or technology requirements, or to complete work that is not possible to handle remotely. The business location will have space available to reserve onsite work when required or necessary. Although there is some flexibility in working hours, the business location and operations are in the Eastern Time Zone and work hours must accommodate interactions, including video conferencing, with colleagues during these hours. Computing resources including required software applications, VPN, desktop or laptop computer, monitor, webcam, keyboard and mouse, will be provided by the employer. Remote staff are not provided with a mobile phone but are provided with computer telephone and fax technology. Office equipment such as desk, chair, and printer are not provided. Basic supplies such as paper and pens, are stocked at the business location and are available to remote staff for pick-up should they choose. Unless otherwise agreed in advance with your manager, additional hardware, software, printing, and cost of office supplies preferred by the staff member, are the responsibility of the employee.

Technology Skills required include the ability to set-up computer and monitors and connect accessory items such as mouse, keyboard, and web cams. Remote computing support is available 24/7 via phone, chat, or ticketing system, to all staff members. Staff will be expected to effectively communicate and resolve most computing issues directly with computing support resources.

Background Screening

Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.

Application Deadline

Job openings are posted for a minimum of seven calendar days. The review and selection process may begin as early as the eighth day after posting. This opening may be removed from posting boards and filled anytime after the minimum posting period has ended.

U-M EEO/AA Statement

The University of Michigan is an equal opportunity/affirmative action employer.

Job Detail

Job Opening ID

247880

Working Title

Outpatient Authorization Specialist

Job Title

Authorization Coord Inter

Work Location

Michigan Medicine - Ann Arbor

Ann Arbor, MI

Full/Part Time

Full-Time

Regular/Temporary

Regular

FLSA Status

Nonexempt

Organizational Group

Um Hospital

Department

MM Cardiovascular Medicine at

Posting Begin/End Date

4/19/2024 - 5/08/2024

Career Interest

Healthcare Admin & Support

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