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Employment Type:

Part time

Shift:

Day Shift

Description:

Authorization Specialist I – Remote – Per Diem

If you are looking for an Authorization Specialist position, on an as needed basis, this could be your opportunity. Here at St. Peter's Health Partner's, we care for more people in more places. This position is located at 425 New Scotland Avenue, Albany, NY

What you will do:

This position is responsible for ensuring appropriate prior authorization for designated specialty. The scope of prior authorizations may include (but is not limited to) consults, diagnostic testing in office procedures and pharmaceuticals including off label drugs, and drugs for clinical trials. The Authorization Specialists will perform all job functions in a courteous and professional manner consistent with the mission and core values of St Peter’s Health Partners Medical Associates.

Responsibilities:

+ Obtains and tracks authorizations/re-authorizations for both new and existing patients in accordance with their insurance policies while following all federal, state, and local medical policy guidelines

+ Initiates Peer to Peer’s with payer while working closely with providers and clinical staff to obtain letters of Medical Necessity to support reimbursement.

+ Monitors all authorization work queue for pending or expiring authorizations.

+ Scans in approval letters after verifying for accuracy.

+ Contacts the insurance company to check status of authorization submission in a timely manner.

+ Troubleshoots authorization denials in efforts to overturn payer behavior related denials.

Qualifications

+ High School Diploma, Associates degree preferred

+ Certification in CCS, CCS-P, CPC or specialty coding preferred

+ One to three years’ experience in a healthcare environment with exposure to service line of position with knowledge of the patient population and types of services patients receiving. Prior authorization experience involving service line drugs and ancillary testing desirable.

+ Two years of experience in reviewing medical records for National Coverage Determinations (NCD) and Local Coverage Determinations (LCD)

+ A strong understanding of HIPAA laws and requirements as they relate to review and reporting of documentation

+ Knowledge of managed care and third-party payer benefits designs and reimbursement requirements

+ Knowledge of ICD-9 and ICD-10 coding and documentation requirements

+ Proficient in Microsoft Office applications including Outlook, Word, and Excel. Preferred experience in EPIC or comparable EMR system

+ Strong analytical skills with attention to detail and a high degree of accuracy in order to produce reports, analyses and other detail as requested

+ Knowledge of drug regimens and associated regulations/policies/procedures applicable to insurance coverage and the associated payment for the appeal of procedures/billing rejected

+ Demonstrated experience with delivering successful customer service

+ Demonstrated experience with handling multiple priorities in a deadline driven environment

**Pay Range** : $19.20 - $25.85

Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran