Authorization Specialist

Imagine a career at one of the nation's most advanced health networks.

Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work.

LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.

Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.

Summary

Obtains benefits and authorizations for surgical procedures, diagnostic testing, medications, outgoing referrals, and other services as part of daily operations. Determines the authorization protocols for each health plan and performs billing duties to ensure proper and timely payment is received from insurance carriers and patients.

Job Duties

• Collaborates with physicians and provider office staff in ascertaining the appropriate authorization based on medical necessity and the treatment plan provided.
• Performs a medical necessity check to determine if procedure and diagnosis support medical necessity.
• Ensures authorizations are obtained in accordance to network policy (any authorization not falling into policy guidelines is communicated to ordering office, patient, and manager).
• Communicates direct/indirect with insurance companies to obtain insurance verification, benefits and precertification for approval.
• Verifies additional clinical information and insurance authorizations/referrals.
• Reviews and monitors WQs/schedules to ensure that proper and accurate authorization has been received prior to patient’s visit.
• Maintains compliance with benchmark data regarding accounts registered versus scheduled procedures.
• Determines estimated patient financial responsibility using insurance verification information and payer contracts and/or self-pay guidelines.

Minimum Qualifications

• High School Diploma/GED with specialized training in insurance, coding, billing, or similar healthcare certificate programs.
• 1 year in a healthcare setting with insurance verification/authorizations.
• Familiarity with billing procedures and payer reimbursement.
• Knowledge of patient rights and laws relative to those rights, such as HIPAA.
• Proficient in utilization management processes, standards, and managed care.
• Proficient in standard medical practices and insurance benefit structures.

Preferred Qualifications

• Associate’s Degree

Physical Demands

Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities.

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Lehigh Valley Health Network does not accept unsolicited agency resumes. Agencies should not forward resumes to our job aliases, our employees or any other organization location. Lehigh Valley Health Network is not responsible for any agency fees related to unsolicited resumes.

Work Shift

Day Shift

Address

1601 Medical Dr

Primary Location

Pottstown - 1601 Medical Drive

Position Type

Onsite

Union

Not Applicable

Work Schedule

M-F; 8a-5p

Department

1012-35172 LVPG-L Pulmonary and Critical Care Medicine - Lower Pottsgrove