授权专员
Authorization Specialist
在国家最先进的医疗网络之一开启职业生涯。
成为卓越医疗体验的一部分。加入Lehigh Valley Health Network充满激情和使命感的团队，这是一家全国知名的、具有前瞻性的组织，提供大量机会去完成出色的工作。
LVHN已连续23年被《美国新闻与世界报道》评为"最佳医院"。我们是Magnet(tm)医院，曾五次获得美国护士认证中心的杰出护理卓越奖，以在利哈伊山谷地区实现护理卓越和优质患者结果而著称。最后，Lehigh Valley Hospital - Cedar Crest、Lehigh Valley Hospital - Muhlenberg、Lehigh Valley Hospital- Hazleton和Lehigh Valley Hospital - Pocono在2020年均获得了The Leapfrog Group颁发的医院安全评分中的"A"级，这是患者安全方面的最高评分。这些荣誉凸显了LVHN对团队合作、同理心和技术的承诺，并始终专注于每天提供最佳的医疗服务。
无论您是在考虑下一次职业发展还是第一份工作，都应该考虑Lehigh Valley Health Network。
简介
作为日常运营的一部分，获取手术程序、诊断测试、药物、转诊和其他服务的福利和授权。确定每种健康计划的授权协议，并执行账单职责，以确保从保险公司和患者处获得正确及时的付款。
职位职责
· 与医生和医疗机构工作人员协作，根据医疗必要性和提供的治疗方案确定适当的授权。
- 进行医疗必要性检查，以确定程序和诊断是否符合医疗必要性。
- 确保按照网络政策获得授权（任何不符合政策指南的授权都会通知开单办公室、患者和经理）。
- 直接/间接与保险公司沟通，获取保险验证、福利和预认证以获得批准。
- 验证额外的临床信息和保险授权/转诊。
- 审查和监控WQ/日程安排，以确保在患者就诊前已获得正确且准确的授权。
- 保持与注册账户与计划程序之间基准数据的合规性。
- 使用保险信息确定患者的预估财务责任。
查看英文原文
Imagine a career at one of the nation's most advanced health networks.
Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work.
LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.
Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.
Summary
Obtains benefits and authorizations for surgical procedures, diagnostic testing, medications, outgoing referrals, and other services as part of daily operations. Determines the authorization protocols for each health plan and performs billing duties to ensure proper and timely payment is received from insurance carriers and patients.
Job Duties
· Collaborates with physicians and provider office staff in ascertaining the appropriate authorization based on medical necessity and the treatment plan provided.
- Performs a medical necessity check to determine if procedure and diagnosis support medical necessity.
- Ensures authorizations are obtained in accordance to network policy (any authorization not falling into policy guidelines is communicated to ordering office, patient, and manager).
- Communicates direct/indirect with insurance companies to obtain insurance verification, benefits and precertification for approval.
- Verifies additional clinical information and insurance authorizations/referrals.
- Reviews and monitors WQs/schedules to ensure that proper and accurate authorization has been received prior to patient’s visit.
- Maintains compliance with benchmark data regarding accounts registered versus scheduled procedures.
- Determines estimated patient financial responsibility using insurance verification information and payer contracts and/or self-pay guidelines.
Minimum Qualifications
· High School Diploma/GED with specialized training in insurance, coding, billing, or similar healthcare certificate programs.
- 1 year in a healthcare setting with insurance verification/authorizations.
- Familiarity with billing procedures and payer reimbursement.
- Knowledge of patient rights and laws relative to those rights, such as HIPAA.
- Proficient in utilization management processes, standards, and managed care.
- Proficient in standard medical practices and insurance benefit structures.
Preferred Qualifications· Associate’s Degree
Physical Demands
Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.
Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities.
Lehigh Valley Health Network does not accept unsolicited agency resumes. Agencies should not forward resumes to our job aliases, our employees or any other organization location. Lehigh Valley Health Network is not responsible for any agency fees related to unsolicited resumes.
Work Shift:
Day ShiftAddress:
1200 S Cedar Crest BlvdPrimary Location:
REMOTE IN PENNSYLVANIAPosition Type:
RemoteUnion:
Not ApplicableWork Schedule:
Monday-Friday 8:00a-4:30pDepartment:
1004-13036 COH-Precertification DeptOriginally posted on Himalayas