Baptist Health Authorization Specialist

The incumbent will be responsible to request, follow-up, obtain, and validate authorizations/referrals/notifications with appropriate CPT and ICD-10 codes, within the appropriate timelines for Radiation Oncology and/or Oncology Infusion. This position requires the incumbent to be in a call center type environment and responsible for meeting individual quality metrics. Responsible for coordinating patient flow, timely processing, maintaining knowledge and deployment of practices used within the department/physician practice/hospital to address patient questions or concerns. Maintaining knowledge of insurance requirements, BHSF pricing, financial assistance options, and overall BHSF Revenue Cycle operations. Practices the Baptist Health philosophy of service excellence in providing professional, compassionate and friendly service to patients of all ages, families, employees, physicians and community members.

Qualifications:

Degrees:

• High School,Cert,GED,Trn,Exper.

Additional Qualifications:

• For internal staff: A minimum of 3 years experience in validating/obtaining authorizations and has demonstrated the ability to independently perform all functions within the Level 1 job description.
• Meets/exceeds all Individual Performance Standards for at least the most recent 6 months.
• Exceeds departmental KPIs and is cross trained in multiple areas/product lines to substitute all staff positions as needed.
• For external staff: Associates Degree preferred with 3 years experience in validating/obtaining authorizations with insurance payers, or 4 years experience in lieu of degree.
• Association of Community Cancer Center, Prior Authorization On-Demand Webinars to be completed within 3 months of hire, and updated yearly education required.
• Complete and pass the Patient Access training course.
• Ability to work in a fast-paced work environment and perform basic mathematical calculations.
• Desired: Knowledge of healthcare regulatory guidelines to include, but not limited to, HIPAA, AHCA, EMTALA.
• Knowledge of authorization guidelines for Radiation Oncology/Oncology Infusion.
• Understanding of insurance contracts, medical terminology, authorizations and pre-certifications.
• Working knowledge of the Microsoft Office products and EMR applications.
• Bilingual English, Spanish/Creole.

Minimum Required Experience:

EOE, including disability/vets