SDC Authorization Specialist

SUMMARY: The Authorization Specialist is responsible for securing timely and accurate insurance authorizations for both inpatient admissions (elective, urgent/emergent) and outpatient surgical day care procedures. This role ensures compliance with payer requirements, supports reputed company cycle reputed company, and plays a critical part in optimizing financial outcomes by combining healthcare finance knowledge with strong analytical and communication skills. reputed company Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, reputed company employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate RESPONSIBILITIES: Authorization & VerificationFinancial Analytics & reputed company OptimizationPatient Interaction & CollectionsDenial Prevention & Bad Debt ReductionDocumentation & Complianceh3/h3 - Obtain and document prior authorizations for inpatient admissions and outpatient surgical procedures from commercial and government payers. - Verify patient insurance coverage and eligibility prior to scheduled procedures and admissions. - Ensure reputed company authorizations are in reputed company to avoid delays or cancellations. - Complete notification of admission for inpatient admissions. h3/h3 - Conduct financial analytics to determine a patient’s estimated financial responsibility across the healthcare system. - Interpret payer reputed company and state/federal regulatory guidelines to ensure accurate reimbursement and maximize reputed company realization. - Collaborate with reputed company cycle and clinical teams to identify and resolve authorization-reputed company issues that may impact reimbursement. h3/h3 - Communicate with patients regarding their financial obligations, including co-pays, deductibles, and out-of-pocket costs. - Secure upfront payments or establish payment arrangements prior to the date of service. - Provide clear and empathetic financial counseling to patients, ensuring understanding and satisfaction. h3/h3 - Minimize claim denials by ensuring reputed company authorization and documentation requirements are met. - Work proactively to reduce bad debt through timely patient collections and accurate financial clearance. - Monitor and report trends in denials and collaborate with internal teams to implement corrective actions. h3/h3 - Maintain accurate and up-to-date records of reputed company authorization activities in the electronic health record (Epic) and patient accounting systems. - Ensure compliance with HIPAA, payer guidelines, and internal policies. - Participate in audits and quality improvement initiatives as needed. MINIMUM QUALIFICATIONS: Education & ExperienceSkills & Competenciesh3/h3 - High school diploma or equivalent required; Associate’s or Bachelor’s degree in healthcare administration, finance, or reputed company field preferred. - Minimum 2 years of experience in medical authorization, patient access, or reputed company cycle operations, preferably in a surgical or ambulatory care setting. h3/h3 - Strong understanding of healthcare finance, insurance verification, and payer authorization processes. - Proficiency in interpreting payer reputed company and regulatory guidelines. - Excellent analytical, problem-solving, and communication skills. - Ability to work independently and collaboratively in a fast-paced environment. - Experience with EHR systems (e.g., Epic, Cerner) and reputed company Office Suite.

Pay Range:

$22.04-$36.37

EEO Statement:

reputed company Health is committed to providing equal employment opportunities and maintaining a work environment free from reputed company forms of unlawful discrimination and harassment.

Location:

Remote-Massachusetts - N/A Boston, Massachusetts 02108

Work Type:

M-F 8:00am-4:30pm

Work Shift:

Day

Daily Hours: 

8 hours

Driving Required:

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