You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.
Job Summary
Our client is seeking an experienced Authorization Specialist to join their team. The primary responsibilities include submitting authorizations, verifying requirements for surgical and cardiac catheterization cases, and performing comprehensive financial clearance for scheduled visits.
Key Responsibilities
- Submit authorizations and verify requirements for surgical and cardiac catheterization cases.
- Perform comprehensive financial clearance for upcoming scheduled visits, including insurance verification, pre-registration, and authorization.
- Review and address authorization mismatches or denials where coded procedures differ from what was originally pre-authorized.
- Serve as a QA specialist for the AI utilization bot, ensuring accuracy and proper workflow adherence.
- Determine whether reauthorization or same-day authorization is available when discrepancies or mismatches occur.
- Prepare and submit authorization requests with appropriate clinical documentation to commercial and government payers.
- Follow up with payers to obtain timely authorization determinations, escalating issues as needed to secure pre-service approval.
- Track, prioritize, and document all authorization requests, maintaining detailed and accurate records of outcomes.
- Ensure written documentation from third-party payers is obtained and properly filed.
- Complete assignments based on daily priorities while following established departmental guidelines.
- Align daily duties with standard authorization workflows while managing unique processes specific to surgical and specialty projects.
Qualifications
- Strong background in hospital authorizations for scheduled and elective services.
- Proficiency with multiple payers, including Medicaid, Medicare, HMOs, and advantage plans.
- Knowledge and experience in submitting authorizations for surgical or cardiac procedures.
- Understanding of third-party vendors like Evacore or Quantum.
- Tech-savvy and comfortable with AI.
- Basic coding knowledge (like modifiers 50 for bilateral, left, right) is preferred but not required.
Skills
- Technical skills including proficiency with AI and understanding of healthcare authorization processes.
- Strong communication and organizational skills.
Additional Requirements
The position requires working Monday to Friday from 9 am to 5 pm.
Benefits
- Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
- Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
- 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
- Short Term Disability Insurance.
- Term Life Insurance Plan.
Required Employment / Compliance Language
Employment is contingent upon compliance with all applicable regulations and policies. Potential candidates must successfully pass all screening requirements and adhere to all organizational protocols.
*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
Medix Overview:
With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.
*As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
