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Medical Authorization Specialist

Methodist Health System • Dallas, TX • 3w ago

Hours of Work :

Days Of Week :

Mon-Fri

Work Shift :

8X5 Day (United States of America)

Job Description :

Your Job:

The Medical Authorization Specialist professional responsible for verification of medical coverage, along with notification, prior authorization, and/or pre-determination of healthcare benefits for proposed medical services, to ensure reimbursement for rendered care. This position routinely works with physicians, clinic support staff, case managers, nurses, insurance utilization management staff, and patients to initiate pre-authorization and resolve issues that arise during the prior authorizations process. Supports and promotes the vision, mission, and strategic plans of Methodist Health System

Your Job Requirements:

High School Graduate or equivalent. Some college preferred

1 year of prior clinical and/or insurance experience.

Knowledge of billing practices and clinic policies and procedures.

Knowledge of ICD-9, ICD-10 and CPT codes for clinic operating policies.

Strong proficiency using Microsoft Office products

Strong oral and written communication skills

Detail oriented, logical, and methodological approach to problem solving

Your Job Responsibilities:

Communicate clearly and openly

Build relationships to promote a collaborative environment

Be accountable for your performance

Always look for ways to improve the patient experience

Take initiative for your professional growth

Be engaged and eager to build a winning team

Ability to interpret Payer Clinical Policies in reference to practice procedures.

Contacts Payer(s) in a timely manner to obtain, monitor, expedite, and track pre-authorization/pre-certification requests for planned services. Monitors changes in Authorization requests daily, to ensure a faster mode of notification retrieval.

Identifies and provides accurate CPT/ ICD codes on the authorization request.

Maintain appropriate logs or reports according to professional, state and federal requirements

Refers authorization requests that require clinical judgment to the Provider, and/or Billing Manager, when necessary.

Advises Manager of all patient complaints, and asks for assistance if problem resolution has not occurred with the patient

Adheres to patient and office confidentiality guidelines as outlined by the policies and procedures of the office and hospital system as well as HIPPA, red flag regulations, and any other polices that relate to compliance to federal program guidelines

Methodist Medical Group is the North Texas physician organization affiliated with Methodist Health System. Our fast-growing network of providers includes more than 60 healthcare clinics, an urgent care clinic, and a virtual care service known as MethodistNOW. Our employees enjoy not only competitive salaries but also the outstanding benefits package of Methodist Health System, which includes medical, dental, and vision insurance; a matched retirement plan; an employee wellness program; and more. The opportunities for career growth are equally generous. Our affiliation means being part of an award-winning workplace:

150 Top Places to Work in Healthcare by Becker's Hospital Review , 2023

Top 10 Military Friendly® Employer, Gold Designation, 2023

Top 10 Military Spouse Friendly® Employer, 2023

Methodist Health System is a faith-based organization with a mission to improve and save lives through compassionate, quality healthcare. For nearly a century, Dallas-based Methodist Health System has been a trusted choice for health and wellness. Named one of the fastest-growing health systems in America by Modern Healthcare , Methodist has a network of 12 hospitals (through ownership and affiliation) with nationally recognized medical services, such as a Level I Trauma Center, multi-organ transplantation, Level III Neonatal Intensive Care, neurosurgery, robotic surgical programs, oncology, gastroenterology, and orthopedics, among others. Methodist has more than two dozen clinics located throughout the region, renowned teaching programs, innovative research, and a strong commitment to the community. Our reputation as an award-winning employer shows in the distinctions we've earned:

Magnet® designations for Methodist Dallas, Methodist Charlton, Methodist Mansfield, and Methodist Richardson Medical Centers

150 Top Places to Work in Healthcare by Becker's Hospital Review , 2023

Top 10 Military Friendly® Employer, Gold Designation, 2023

Top 10 Military Spouse Friendly® Employer, 2023

Equal Opportunity Employer

It is the policy of Methodist Health System (MHS) to select, develop, and promote employees based on individual ability and job performance. It has been, and will continue to be, the policy of MHS to provide equal employment opportunity to all people in all aspects of employer-employee relations without discrimination because of race, color, religion, national origin, age, sex, sexual orientation, gender expression, disability, marital status, genetic information or ancestry. This policy affects decisions including, but not limited to, an employee's compensation, benefits, terms and conditions of employment, opportunities for promotion, training, development, transfer all other privileges of employment. MHS is committed to maintain a working environment free of intimidation, workplace discrimination and harassment. Retaliation or attempted retaliatory behavior that occurs as a result of an employee's exercise of their rights under this policy or any other statutorily protected right is strictly prohibited and will be grounds for disciplinary action.

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