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At Children’s Nebraska, our mission is to improve the life of every child through exceptional care, advocacy, research and education. As the state’s only full-service pediatric healthcare center, we provide comprehensive, holistic care to our patients and families—from primary and specialty care to behavioral health services and everything in between. Dedicated to a People First culture, we foster an environment with joy, belonging, wellbeing, learning and growth. Turn your passion into purpose and make a difference where it matters most.

A Brief Overview

The Authorization Specialist plays a critical role in ensuring patients receive timely and appropriate care by coordinating insurance authorizations for a variety of healthcare services. This role is responsible for verifying insurance coverage, obtaining prior authorizations, and managing denials by collaborating with clinical, administrative, and financial teams. The Authorization Specialist supports efficient operations by ensuring compliance with payer requirements and maintaining up-to-date information in the hospital's electronic health record (EHR) system.

Essential Functions

+ Authorization Coordination

+ Verify insurance coverage and obtain prior authorizations for a range of scheduled outpatient services.

+ Ensure the accuracy of CPT codes before submitting authorization requests to insurance carriers.

+ Document patient information such as diagnosis, referring physician, and insurance details in the EHR system to initiate referrals or pre-certifications.

+ Monitor payer policies and procedures to stay current on authorization requirements.

+ Collaborate with internal and external clinics to facilitate smooth workflows for authorization requests.

+ Provide expertise and support to other departments to address authorization needs and ensure compliance with organizational standards.

+ Denial Management

+ Identify and resolve authorization-related denials by working closely with clinical teams, payers, and billing departments.

+ Facilitate peer-to-peer reviews and appeals for denied authorizations.

+ Utilize EHR work queues to track upcoming services requiring authorization and ensure timely follow-up.

+ Collaboration and Communication

+ Escalate to Financial Clearance Manager to address cases where insurance coverage is terminated or limited.

+ Collaborates with Financial Service Advocate II for assistance when financial support or additional resources are needed.

+ Communicate with Leadership, clinical team, and families to resolve issues impacting the authorizations scheduled procedures.

+ Reporting and Documentation

+ Report authorization denials to supervisors and management to determine appropriate actions, such as rescheduling or canceling services.

+ Maintain accurate documentation of all authorization-related activities in the EHR system.

+ Provide timely updates on authorization statuses to clinical and administrative teams.

+ Regular attendance at work is an essential function of the job.

+ Perform physical requirements as described in the Physical Requirements section

Education Qualifications

+ High School Diploma or GED Required and

Experience Qualifications

+ Minimum of 1 year of experience in insurance verification, authorization, and/or billing within a healthcare setting. Required

Skills and Abilities

+ Strong knowledge of medical coding systems (CPT, ICD-10) and payer requirements.

+ Proficiency in using Epic or similar EHR systems.

+ Detail-oriented with a focus on accuracy and compliance.

+ Strong problem-solving skills, particularly for resolving authorization denials.

+ Exceptional interpersonal skills for collaborating with patients, families, and multidisciplinary teams.

+ Ability to adapt to changing payer requirements and organizational needs.

+ Excellent organizational, time management, and communication skills.

+ Ability to work in a fast-paced environment and manage multiple priorities.

+ Knowledge of HIPAA regulations and commitment to patient confidentiality.

Children’s is an equal opportunity employer, embracing and valuing the unique strengths and differences of people. We cultivate an inclusive environment of respect and trust where we all belong. We do not discriminate based on race, ethnicity, age, gender identity, religion, disability, veteran status, or any other protected characteristic.

At Children’s Nebraska, our mission is to improve the life of every child through exceptional care, advocacy, research and education. As the state’s only full-service pediatric healthcare center, we provide comprehensive, holistic care to our patients and families—from primary and specialty care to behavioral health services and everything in between. Dedicated to a People First culture, we foster an environment with joy, belonging, wellbeing, learning and growth. Turn your passion into purpose and make a difference where it matters most.

**Requisition ID** : 22906