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Authorization Processor Jobs in Delaware (NOW HIRING)

Nemours

Orthopedic Authorization Liaison

Wilmington, DE · On-site

During the referral process the Liaison will partner with the Primary Care Practitioner to obtained ... During the authorization and notification process the Liaison will provide the payor with all ...

ChristianaCare

Specimen Processing Techician I

Newark, DE · On-site

$19.10 - $27.69/hr

Job Details Applicants must be currently authorized to work in the United States. ChristianaCare ... Process, sort, and deliver laboratory specimens and request slips * Print and properly affix ...

State of Delaware

Judicial Case Processor I

Wilmington, DE · On-site

$35K - $41K/yr

Conditions of Hire Applicants must be legally authorized to work in the United States. The State of ... Process The application and supplemental questionnaire are evaluated based upon a rating of your ...

ChristianaCare

Manager, Patient Access

Wilmington, DE · On-site

Manage the enterprise operational performance and quality function supporting registration and authorization processes across the organization * Oversee daily analytical operations, workload ...

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Authorization Processor information

What is an authorization processor?

Authorization Processors are professionals responsible for reviewing, verifying, and processing requests for access, permissions, or approvals, often in banking, insurance, or healthcare industries. Their main duties include checking documentation, ensuring compliance with company policies and regulations, and facilitating the approval or denial of authorization requests. They play a crucial role in preventing unauthorized transactions and maintaining the integrity of sensitive processes. Attention to detail, strong organizational skills, and a solid understanding of regulatory requirements are essential for this position.

What are the key skills and qualifications needed to thrive as an authorization processor, and why are they important?

To thrive as an Authorization Processor, you need a keen attention to detail, knowledge of insurance policies, and experience with healthcare or financial authorization processes, often supported by a high school diploma or equivalent. Familiarity with claims management systems, electronic health records (EHR), and insurance verification software is typically required. Strong organizational skills, clear communication, and problem-solving abilities help you efficiently manage requests and collaborate with clients and internal teams. These competencies ensure accurate, timely processing of authorizations, which is critical for preventing delays in patient care or financial transactions.

What are the most common challenges faced by authorization processors, and how can applicants prepare for them?

Authorization Processors often face challenges such as managing a high volume of requests, staying current with shifting insurance policies, and ensuring accuracy under tight deadlines. To prepare, applicants should develop strong organizational skills, attention to detail, and the ability to quickly learn new software or procedures. It's also helpful to familiarize yourself with healthcare terminology and payer requirements, as this knowledge will make it easier to navigate complex authorization cases and communicate effectively with providers and insurance representatives.

What is the difference between Authorization Processor vs Claims Processor?

AspectAuthorization ProcessorClaims Processor
Required CredentialsHigh school diploma or equivalent; certifications like Certified Healthcare Access Associate (CHAA) are commonHigh school diploma or equivalent; certifications like Certified Claims Professional (CCP) are common
Work EnvironmentHealthcare facilities, insurance companies, or third-party administratorsInsurance companies, healthcare providers, or third-party claims processing centers
Job FocusReviewing and authorizing patient services or insurance coverageProcessing and adjudicating insurance claims for reimbursement
Common TasksVerifying coverage, obtaining authorizations, communicating with providersExamining claim details, coding, approving or denying claims

While both roles involve working within healthcare and insurance settings, Authorization Processors focus on approving patient services and verifying coverage, whereas Claims Processors handle the processing and adjudication of insurance claims for reimbursement. Understanding these differences helps in choosing the right career path or job search focus.

What are popular job titles related to Authorization Processor jobs in Delaware?

For Authorization Processor jobs in Delaware, the most frequently searched job titles are:

What job categories do people searching Authorization Processor jobs in Delaware look for?

The top searched job categories for Authorization Processor jobs in Delaware are:

What cities in Delaware are hiring for Authorization Processor jobs?

Cities in Delaware with the most Authorization Processor job openings:

Authorization Processor jobs near you

Orthopedic Authorization Liaison

Nemours Children's Hospital Orlando

Wilmington, DE • On-site

Other

Re-posted 7 days ago

Job description

Orthopedic Authorization Liaison

Nemours is seeking an Orthopedic Authorization Liaison to join our Nemours Children's Health team in Wilmington, DE.

The Orthopedic Authorization Liaison is responsible for optimizing payment of services by obtaining and processing Elective, Urgent, and Emergent referrals and authorizations for Orthopedic patients with non-participating insurance including but not limited to out-of-state Medicaid plans and commercial insurance plans. The Liaison is also responsible researching and notifying family of co-payment responsibilities. Referrals and authorizations are obtained prior to the date of service. During the referral process the Liaison will partner with the Primary Care Practitioner to obtained required referrals. The Liaison will be a leader in working with outside groups to educate around the referral/auth process. During the authorization and notification process the Liaison will provide the payor with all patient information and requested documentation necessary to obtain admission approval. This role is required to utilize all available resources to verify eligibility, benefit levels, and patient copayment responsibilities.

This position collaborates with: Hospital and Physician Authorization departments, non-Nemours physician offices, managed care department, Nemours Physicians, and Departmental Administrative Staff to ensure that accurate information is collected and distributed effectively and efficiently. The Liaison utilizes daily reports and work queues to complete follow up on non-approved cases and assure completion prior to appointment or admission date according to department standards. In addition, the Liaison will report weekly on payor issues, barriers impacting workflows, and specific issues that could result in a non-reimbursable visit. The Liaison will have the ability to cover all referral and authorization types and demonstrate effective utilization of EPIC applications as indicated by performance measures. This position will also assist with educating the Orthopedic Surgical Coordinators and other clinical and non-clinical team members on high-level processes and act as a resource for the department.

Essential Functions

  • Ensure timely notification and request for authorization/referrals is handled in accordance with policy and payor requirements.
  • Maintaining confidentiality, verify patient demographics, insurance eligibility, benefits, and financial responsibility.
  • Ability to request/obtain authorizations/referrals for Orthopedic patients with non-participating insurance.
  • Contact families, primary care providers, and other allied health professionals to obtain necessary information and assist with insurance issues preventing authorization/referrals.
  • Knowledge of participating and non-participating insurances, billing, Epic work queues, insurance authorization requirements, CPT and ICD-10 codes, managed care, utilization management, financial estimates, and medical terminology.
  • Develop spreadsheets and databases to analyze data, track authorization and denial trends, and report patterns.
  • Clearly document all communications and contacts with payors and families in standardized documentation requirements including proper format.
  • Provides back-up to the Access Center Specialist role as needed.

Requirements

High School Diploma or equivalent required; Associate's Degree preferred

Certified Revenue Cycle Representative (CRCR) and/or Certified Healthcare Financial Professional (CHFP) is required

SuperUser certification is preferred

Minimum five years of referral and / or authorization experience is required.

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