Authorization Specialist II

About the Role

The Authorization Specialist II is responsible for collaborating with insurance payers and clinical staff at SouthEast Alaska Regional Health Consortium (SEARHC) to obtain initial and ongoing patient service authorizations. This includes verifying insurance benefits, managing authorizations per payer-provider agreements, and accurately maintaining insurance data within the electronic medical record system. Exceptional communication and customer service skills are essential, as this role interacts with internal teams and external payers to ensure proper reimbursement, especially for high-value procedures.

Key Duties

• Understand and embody SEARHC's Mission, Core Values, and Vision in all professional activities and decisions.
• Foster positive teamwork and collaborate effectively with peers and colleagues to meet departmental goals.
• Maintain confidentiality and privacy in all communications and data handling.
• Report concerns appropriately and adhere to organizational policies.
• Deliver excellent customer service to both internal staff and external clients.
• Track and document all inbound and outbound patient and physician office authorizations.
• Obtain insurance authorizations through phone, email, or written correspondence with various carriers.
• Handle authorization denials and coordinate appeals with Revenue Cycle and clinical teams.
• Collaborate closely with Financial Counselors and Patient Access staff to verify and document current coverage accurately.
• Ensure documentation aligns with insurance verification, registration, and billing requirements; follow up as required.
• Respond promptly to inquiries regarding authorization statuses by assessing and providing relevant information.
• Communicate effectively regarding any delays or issues impacting patient appointments and authorizations.
• Consistently meet or exceed team metrics and expectations.
• Identify compliance or ethical issues and recommend improvements.
• Adhere strictly to organizational policies and procedures, including any updates.
• Perform other patient access-related duties as assigned.

Required Qualifications

• High school diploma or equivalent is required.
• Certification as a Certified Healthcare Access Associate (CHAA) must be obtained within six months of hire.

Preferred Experience

• Minimum of two years as an Authorization Specialist preferred, or
• Two years of experience in healthcare, office, or customer service roles may be considered.

Knowledge and Skills

• Understanding or willingness to learn tribal health programs and alternative resources.
• Customer service principles and practices.
• Data entry, retrieval, and reporting capabilities.
• Medical terminology and relevant coding systems including ICD-10CM, CPT, and HCPCS.
• Insurance authorization and benefits processes.
• Basic anatomy and physiology knowledge.
• General office functions and proficiency with office equipment and computer applications.
• Attention to detail with strong organizational skills.
• Effective oral and written communication skills.
• Ability to use databases and various software applications efficiently.
• Proven capacity to work independently and collaboratively within a team setting.
• Strong interpersonal communication skills.
• Competency in multitasking, prioritization, and problem-solving in fast-paced environments.
• Professional demeanor when interacting with healthcare professionals and clinical teams.

Additional Information

• Work consists of a full-time 40-hour week schedule with potential overtime.
• Compensation ranges from $25.00 to $33.71 per hour.
• A $1,000 sign-on bonus at the start and an additional $1,000 bonus after 12 months are available for qualified candidates.
• SEARHC offers comprehensive benefits including retirement plans, paid time off, paid parental leave, health, dental, vision insurance, life insurance, and disability coverage.
• The organization emphasizes employee development and views employees as its greatest asset.

If you enjoy dynamic growth and working alongside enthusiastic professionals, SEARHC offers a rewarding career opportunity.