Authorization Specialist - Endocrinology Job at "name" : "Summit Health Management, LLC
"name" : "Summit Health Management, LLC Berkeley Heights, NJ
Career Opportunities at Summit Health and CityMD
Summit Health and CityMD form a physician-driven, patient-centric network, committed to simplifying the complexities of health care and bringing a more connected kind of care. Our unique network was created by the 2019 merger between Summit Medical Group, one of the nation’s premier independent multispecialty medical groups, and CityMD, the leading urgent care provider in the New York metropolitan area. Together, Summit Health and CityMD deliver a more intuitive, comprehensive, and responsive care experience for every patient, regardless of the stage of life or health condition, through high-quality primary, specialty, and urgent care.
We are continually growing to meet the needs of our patients and deliver exceptional care to an even greater population. Summit Health now has more than 2,800 providers across more than 80 specialty areas, 13,000 employees, and over 370 locations in New York, New Jersey, Connecticut, Pennsylvania, and Central Oregon. CityMD has over 150 locations across the tri-state. We share a vision of improving the way health care needs are addressed by offering timely, high-quality, comprehensive care with an exceptional patient experience. Together, we provide the best possible care to every patient in every neighborhood.
Join our team!
Summit Health and CityMD are dedicated to hiring and retaining the right talent who will contribute to our ongoing expansion and success. We work to set clear goals and expectations, while regularly managing performance and cultivating personal and team capabilities within a positive, collaborative environment that recognizes and rewards success. We strive to make each team member's experience at our company inspiring. Explore our open positions and apply to become a part of the Summit Health and CityMD family.
Job Description
Job Description
The Authorization Specialist is responsible for obtaining authorizations for surgical procedures, diagnostic testing, medications, DME, outgoing referrals, and other services as part of the daily operations. Authorization Specialists must have a keen understanding of medical insurance and the clinical policies that determine the authorization protocols for each health plan.
Essential Job functions:
- Identifies all appointments and procedures for assigned departments that require authorization by monitoring the schedules, system reports, and dashboards
- Identifies the referral and authorization requirements of the patients’ insurance plans by using various on-line resources according to department workflows
- Demonstrates knowledge of insurance carrier guidelines , clinical policies, and state guidelines pertaining to referrals and prior authorization
- Verifies insurance eligibility and benefits, and updates the patient’s insurance information as necessary
- Completes referrals and prior authorizations in a timely manner according to department guidelines and workflows
- Communicates clearly and effectively with patients, physicians, office staff and manager to resolve issues that may result in a denied or delayed authorization request.
- Demonstrates complete system knowledge, ability to run reports, document and manage referrals and authorizations, move correspondence, resolve eligibility and authorization holds, and other system tasks within the user’s security access
- Demonstrates the ability to request, prepare, and recognize the documentation required to support the medical necessity for the service being authorized
- Provides the supervisor and manager with immediate feedback on issues affecting workflow, reimbursement, and customer service.
- Ensures that appropriate and accurate information is entered in the patient account
- Responds timely and collaborates effectively with the Reimbursement Department teams to limit denials and ensure proper reimbursement
- Collaborates with team members to meet department deadlines and benchmarks
- Demonstrates the ability to use the electronic tools and systems available to organize and process the daily work
- Anticipates and performs necessary job duties.
- Maintains patient confidentiality
General Job functions:
- Expert in selecting the correct insurance package in Athena Collector.
- Updates authorizations and claims to reflect the new insurance package.
- Expert in sorting work queues and reports to identify and process the daily work (Manage Schedules - Inbound Referral Report - Outgoing Referrals)
- Moves correspondence from the dashboard to the patient’s account.
- Expert in generally accepted insurance benefit terms and processes.
- Expert in Communication (Case and authorization notation - Physician and Practice location staff – Peers - Supervisor/Manager – Payers)
- Expert in requesting and preparation of supporting documentation such as medical records, dictation, and orders.
- Expert in investigation of authorization denials and appeals (Insurance – Patient)
Education, Certification, Computer and Training Requirements:
- High School Graduate/GED Required.
- Vocational / Technical School / Diploma Program Preferred
- 2-4 of related experience Preferred
- Experience with Standard Office Equipment (Phone, Fax, Copy Machine, Scanner, Email/Voice Mail) Preferred.
- Experience Standard Office Technology in a Window based environment & Microsoft Office Suite Required.
Total Rewards at Summit Health CityMD
Our team members are essential to our mission to reshape healthcare through the power of connection. Summit Health highly values the critical role that health and wellness play in the lives of our team members and their families. We strive to provide a valuable suite of benefits, wellness programs, compensation, time off, and resources to support the wellbeing and personal needs of team members and their families at various stages of life and in their professional career. Collectively, we call these "Total Rewards“.
Here at Summit Health, our total rewards include, but are not limited to:
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We’ve Got You Covered - Health coverage is vital, and it begins as soon as the 1st of the month after you start employment.
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Build a Healthy Foundation – Various medical plan options, HDHP with HSA option and employer contribution, and waived copays at CityMD Urgent Cares.
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Enhance Your Health Coverage – Dental and vision insurance, plus healthcare and dependent care spending accounts.
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Safeguard Your Household – Company paid EAP and life insurance, plus optional supplemental life, pet, and legal plan insurance.
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Protect Against the Unexpected – Voluntary benefits including hospital indemnity, accident, critical illness, and disability insurance.
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Retirement Investing - 401(k) plan with company match every pay period to help you build towards your retirement.
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Work/Life Balance - Paid time off including PTO, holidays, and more so employees can take a break or care for themselves and their family.
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Paid Maternity Leave - Paid time off for the birth of a child to assist with important time away while welcoming the newest addition to your family.
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Reach Professional Goals – Tuition reimbursement, annual compensation and bonus program, and internal growth opportunities.
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Financial Wellness - Educational webinars, resources, and tools to help foster financial literacy.
Equal Opportunity Employer
Our Company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws.
Safety Disclaimer
Our Company cares about the safety of our employees and applicants. Our Company does not use chat rooms for job searches or communications. Our Company will never request personal information via informal chat platforms or unsecure email. Our Company will never ask for money or an exchange of money, banking or other personal information prior to the in-person interview. Be aware of potential scams while job seeking. Interviews are conducted at select Our Company locations during regular business hours only. For information on job scams, visit,
https://www.consumer.ftc.gov/JobScams
or file a complaint at
https://www.ftccomplaintassistant.gov/
.
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