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Saint Francis Healthcare System offers people a variety of career opportunities that are stimulating, challenging, and above all, rewarding. Known for providing its employees with competitive wages and outstanding benefits, Saint Francis also features a family-focused culture that cultivates a friendly, caring environment for Medical Center employees, physicians, volunteers, and patients.

 

As an equal opportunity employer, Saint Francis does not discriminate on the basis of sex, age, religion, creed, national origin, race, or handicap in its relations with patients, visitors, or employees. Please take time to review the Medical Center’s current job openings and submit an online application for a position for which you are qualified.

 
Job Details
System Authorization Specialist (043004)
 
Job Number: 043004
Job Title: System Authorization Specialist
Number of Openings: 1
Job Type (Employment Type): Full Time, 80 hours per 2 week pay period
City: Cape Girardeau
Job Schedule: Day Shift
Job Category: Clerical
Career Level: Staff
Minimum Level of Education: High School Degree/GED
Years of Experience: 1
 
Position Description

The Authorization Specialist position is responsible for reviewing requests for prior authorization of medical services including elective and outpatient surgeries and procedures, home health, out of network requests, and expedited requests for medical necessity in accordance with government, commercial, and workers compensation health plan coverage guidelines. This individual is responsible for benefit determination and documenting completely and accurately in accordance with healthcare system guidelines. This position works well independently solving problems and acts as liaison with others outside the department to create smooth workflows and transitions of information needed for authorizations. Promotes harmonious and efficient intra and inter departmental relationships and delivers quality customer service. Adheres to the Mission, Vision, Values and Philosophy of the departments and Saint Francis Healthcare System. Constantly works with and maintains restricted or confidential information from many sources within the healthcare system. Any and all duties as assigned by Manager and Director.

Complete patient insurance authorization process - Completes the patient insurance authorization process required for services requested by the clinical staff responsible for the patient's care. Initiates communications with patient's insurance carrier upon receiving information from the clinical team for services that require pre-certification/authorization

Provide records and required information to insurance carriers - Works proactively with insurance carriers to ensure that all of the required information for payment has been received in a timely fashion.

Consistently provides communication - Supports the revenue cycle division of the healthcare system as a working partner with ordering providers and other clinical staff, schedulers, and financial counselors to ensure financial clearance is obtained prior to rendering of services. Conducts provider outreach as it relates to the authorization process and redirection of services. Advises the clinical team of any changes in insurance companies reimbursement practices related to the authorization process. Maintains ongoing communication with the treating clinical team during the authorization process to provide timely updates on the outcomes of the requests for services from insurance carriers.

Position Requirements

Degree/Diploma: High School Diploma

Additional Skills & Experience Requirements: Minimum of one year of experience in a healthcare setting obtaining insurance authorizations preferred. Experience with CPT and ICD codes is a plus.