Authorization Advocate

QUALIFICATIONS:

JOB SPECIFIC CORE COMPETENCIES:

•  Customer Service-oriented: The Authorization Advocate should be extremely customer service-oriented, with a patient first attitude.


•  Communication skills: The Authorization Advocate will have strong written and verbal communication skills, and excellent spelling. Demonstrated knowledge of medical terminology. They will have excellent communication and interpersonal skills, especially when it comes to interacting with patients and other hospital associates over the phone or in person if required.


•  Organizational skills: This role requires strong administrative and organizational skills to help manage responsibilities effectively.


•  Attention to detail: The Authorization Advocate should have the ability to multitask and maintain a strong attention to detail, with good analytical and problem solving skills


• Technical skills: Proficiency in Microsoft Office suite (Outlook, Excel, Word); experience with Meditech preferred but not required.


• Ability to function independently and as a team player in a fast-paced environment.


• Strong written and verbal communication skills and excellent spelling

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

• Independently able to retrieve orders from worklists.


• Able to verify provider orders, authorizations, and locations – ensuring that all information match perfectly.


• Access insurance company databases to gain prior authorizations and pre-certifications.


• Detailed and accurate chart documentation outlining details set forth by department protocol and insurance regulations outlining precertification information for the patient.


• Process referrals efficiently including gathering detailed medical records, contacting the patient to provide updates on their referral status and faxing the referral to the appropriate specialty office.


• Process pre-certifications efficiently including gathering detailed medical records and contacting the patient to provide updates on their order status


• Ongoing communication with specialty offices to ensure that patients have been scheduled with the specialty office they have been referred to


• Excellent and continuous communication between the patient, provider offices, insurance companies and peers


• Maintain patient confidentiality as defined by state, federal and company regulations.


• Validates benefit coverage per established procedures.

• Performs any other task related duties as assigned by the Director.


• All obligations pertaining to the position’s description is subject to change at any time.


• Demonstrate ability to schedule, re-schedule and cancel patients’ appointments throughout Hancock Health


• Demonstrating ability to schedule, re-schedule and cancel patient appointments throughout Hancock Health


• Other Duties as assigned by manager or director.

CERTIFICATION/LICENSE: 

• Successful completion of the CHAM (Certified Healthcare Access Manager) Certification course – NAHAM within 6 months of hire.

ADDITIONAL LICENSURE / CREDENTIAL REQUIREMENTS:

• High School Diploma or equivalent required.

EDUCATION AND EXPERIENCE REQUIREMENTS:

•  Knowledge of medical office practices and procedures.


•  Certified Medical Assistant or Certified Clinical Medical Assistant, or LPN preferred.


•  Associate degree in a related field preferred.


•  Excellent written and verbal communication skills


• Proficiency in Microsoft suite (Outlook, Word, Excel, PowerPoint) is preferred


• Demonstrated ability to use PCs (and toggle between multiple applications), MS Office, and general office equipment (i.e printers, scanners, electronic signature pads, copy machine, multi-line phone, etc.) required.


• Excellent keyboarding/data entry skills required.


•  Comprehension of department-specific associate duties and processes.


•  2-3 years’ experience with pre-cert, referrals and authorization processes strongly preferred.