Job 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. Typical hours for this position: Monday-Friday 8:00am-4:30pm. Opportunity for remote work after 6 months on-site training. Education: High school graduate or equivalent required. Experience: One year of experience in a healthcare setting obtaining insurance authorizations strongly preferred. Experience with CPT and ICD codes is a plus. Saint Francis Healthcare System is committed to a compensation philosophy that aligns to the fiftieth percentile of the marketplace, while also crediting applicable and/or relevant work experience when computing compensation offers for selected candidates. Internal equity is factored into all offers presented to candidates. Saint Francis Healthcare System provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, or genetics. In addition to federal law requirements, Saint Francis Healthcare System complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. In compliance with the ADA Amendments Act (ADAAA) should you have a disability and would like to request an accommodation in order to apply for a currently open position with Saint Francis Healthcare System, please call 573-331-5152 or email us at hr@sfmc.net. Saint Francis Healthcare System supports the overall health and wellness of our colleagues by discouraging the use of tobacco and nicotine products. If you are selected for a career opportunity with our organization, and are a tobacco or nicotine user, you will be required to complete a tobacco/nicotine cessation program within your first year of employment. This program is free of charge as part of our Employee Assistance Program.

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