Authorization Specialist
Core
Provides comprehensive care coordination for patients by assessing plans of care, developing and monitoring resource utilization, and facilitating options to meet health care needs.
Role type
Authorization Specialist (Care Coordination)
Builds
Patient care plans and utilization management processes
Domain
Healthcare / Utilization Management
Deliverable
client delivery
Required skills
Medical terminology, CPT and IDC codes, care coordination, process improvement, regulatory compliance, denial management, payer communication
Preferred skills
Degree in Secretarial Administration, Health Care Administration, Business, or Accounting
Responsibilities
Manages individual patients across the health care continuum; evaluates medical necessity and appropriateness of care; establishes collaborative relationships with physicians, payers, and health care team members; educates internal and external facilities on pre-authorizations and managed care concepts; works on denials to overturn them.
Seniority
Individual Contributor