Authorization Spec-Surg-Ancillary

Skills

We are searching for a talented

Overview Community Focused.
Care Driven.
Southcoast Health, where your future is as promising as the care we provide.
Our commitment to each other, our patients, and our community is more than a mission - it’s our way of life, and you’ll be at the heart of it.
Southcoast Health is a not-for-profit, charitable, health system with multiple hospitals, clinics and facilities throughout Southeastern Massachusetts and Rhode Island.
Nestled in local communities, Southcoast Health provides inclusive, ethical workplaces where our highly skilled caregivers offer world-class, comprehensive healthcare close to home.
Find out for yourself why Southcoast Health has been voted ‘Best Place to Work’ for 7 years in a row!

Position reports to the Team Leader or designee.
Perform a wide variety of duties to secure optimal revenue for all services performed at Southcoast facilities.
Enter orders, schedule/cancel/reschedule appointments, determine patient liability prior to service by creating estimate based on individual payer, notify patients of their potential liability in accordance with Federal & State regulations and collect payment electronically.
Initiate contact w/patients, physicians, third party payers to obtain pre-certification and authorization for all inpatient and outpatient services.
Liaison between third party payers and providers, coordinate peer to peer discussions to authorize surgical and high dollar services.
Use critical thinking skills to ensure CPT codes are documented and authorized for appropriate services.
Partner with Care Coordination to determine and authorize appropriate level of care.
Navigate multiple payer portals to determine requirements for authorization and submit electronic requests.
Work with Pharmacy to determine appropriate infusion medication source and obtain authorization for medication/services.
Follow-up with payer denials by researching clinical data to support an appeal.
Verify coverage and initiate authorization for new patients to be accepted to SE Rehab Department.

Associates Degree in a related field or equivalent combination of education and experience is required; Bachelors Degree preferred.
Strong keyboard skills with the ability to type 40 words per minute.
Proven exceptional customer service skills.
Ability to communicate with physicians, patients and third party payers.
Proficient with navigating multiple payer portals and web based tools.
Over three years of healthcare experience focusing on revenue cycle activities is preferred.
Must be fully vaccinated against seasonal Influenza and the COVID 19 virus or to be exempt from the requirement for medical or personal reasons by signing a statement certifying you are choosing to be exempt from vaccination once hired.

40hrs Shift: Day shift with one minor holiday per year; 8:30am - 5:00pm Location: Southcoast Business Center – Fairhaven, MA A career at Southcoast Health offers you: A culture of well-being that embraces, respects, and celebrates the rich diversity of one another and the communities we serve
Competitive pay and comprehensive benefits package
Generous Earned Time Off Package Employee Wellbeing Program 403B Retirement Plan with company match
Tuition assistance / Federal Loan Forgiveness programs
Professional growth opportunities and customized leadership training Available to regular status employees who are scheduled to work a minimum of 24 hours.