Authorization Specialist

Why work at TidalHealth?

Join a triple 'A' rated team where clinical excellence meets a coastal lifestyle. At TidalHealth, you’ll be part of an award-winning network spanning Maryland and Delaware, recognized by the Leapfrog Hospital Safety Guide for our unwavering commitment to patient care. Whether your expertise lies in specialized clinical fields like neurosurgery, academic mentorship through our graduate medical programs, or the critical professional and support roles that keep our network thriving, we provide the tools and tuition assistance you need to excel.

Authorization Specialist Position Summary

The Authorization Specialist is responsible and accountable for monitoring and submitting all insurance authorizations including but not limited to; prior service, surgical, acute hospital, and post-acute care authorizations, that may include rehabilitation, transportation, medication, durable medical equipment, and home service authorizations that align with medical necessity policies and regulatory requirements for TidalHealth. The Authorization Specialist works collaboratively with Case Managers, Utilization RNs, physician advisors, insurance companies, finance, patients, providers, and authorization process stakeholders, to reduce length of stay, ensure fiscal responsibility, appropriate use of benefits, and streamlining the discharge process. They will also be responsible for maintaining and following up on non-clinical administrative tasks related to utilization review, discharge planning, PCP appointments, regulatory paperwork, invoicing, prior authorizations, benefit verification preservice review, healthcare claims inquiry, appeal/denial tracking, and case documentation.

Authorization Specialist Position Requirements

Education

• Bachelor’s degree in a health-related field or equivalent medical office experience is required.

Experience

• Minimum of three (3) years clinical/medical office and/or related experience required.
• Working knowledge of Microsoft applications, primarily Excel, Outlook and Word is required.
• Experience utilizing EMR systems (EPIC preferred).
• Working knowledge of ICD Diagnostic Codes and medical terminology.

Schedule

• Primarily day shift, Monday through Friday

Authorization Specialist Benefits:

Benefits: We provide a robust benefits suite for our eligible team members (36+ hours for 12-hour shifts; 37.5+ hours for standard shifts):

• Health: Medical (including HSA), Dental, Vision, & Prescription
• Wealth: Matching 403(b), Healthcare FSAs, & Dependent Care FSAs
• Growth: $5,000 Tuition Assistance & Certification support
• Balance: Generous PTO and Holidays, Onsite Child Care, Pet Insurance
• Income Protection & Leave: Employer-Paid Short-Term Disability, Paid Leave Program, & Long-Term Disability (LTD for FT)
• Life & Security: Employer-paid Life and additional voluntary benefits such as Accident, Critical Care, additional Life, and more