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St. Francis Hospital, The Heart Center is New York State's only specialty designated cardiac center. A member of Catholic Health, St. Francis is consistently recognized by U.S. News & World Report as a national leader for Cardiology & Heart Surgery, as well as for Gastroenterology & GI Surgery. Additionally, U.S. News rates St. Francis as high performing in Geriatrics, Neurology & Neurosurgery, Orthopedics, and Pulmonology. Nursing care at St. Francis is also nationally recognized, with multiple Magnet designations, as well as the AMSN PRISM Awards and Beacon Awards. St. Francis has regularly out-scored other hospitals on Long Island.

We are seeking an experienced Authorization Specialist to join our cardiology office, where your expertise will play a crucial role in ensuring our patients receive the care they need seamlessly. This is an exciting opportunity to utilize your skills in obtaining accurate authorizations for various scheduled services, ensuring an efficient process that supports patient care and operational excellence.

Key Responsibilities:

• Review & Verify Patient Coverage: Diligently assess patient insurance coverage and secure the necessary authorizations prior to the provision of services, ensuring full compliance with payer requirements.
• Timely Authorization Requests: Efficiently process authorization requests for both scheduled and add-on procedures with an emphasis on accuracy and speed.
• Communication & Coordination: Keep the team informed about any challenges or delays in obtaining authorization, fostering an open line of communication with office staff.
• Track & Document: Maintain comprehensive records of communication between insurance carriers and facility representatives, ensuring all details are accurately documented.
• Prioritize Requests: Assess and prioritize incoming authorization requests based on urgency to maintain workflow efficiency.
• Review Documentation: Ensure that documentation meets medical policy guidelines to expedite the approval process.
• Utilize Payer Resources: Effectively obtain authorizations via payer websites or phone calls, consistently following up on pending cases to achieve timely approvals.
• Notify Leadership: Proactively inform department leadership about potential missed deadlines and escalate cases when necessary.
• Liaison Role: Act as a vital link between patient account services and physicians, developing validated daily work lists to guide daily operations.
• Audit Assistance: Support insurance and regulatory audits by providing relevant information to management regarding documentation discrepancies.
• Process Improvement: Analyze existing workflows to identify opportunities for improvement and reduction of denials.
• Team Collaboration: Participate in ongoing projects as necessary, meet productivity standards, and contribute to team meetings and committees as required.
• Flexible Support: Provide backup for check-in processes and assist with Epic patient access work queues as needed.

Position Requirements & Qualifications:

Education/Experience:

• Proven knowledge of CPT and ICD-10 coding, with strong written communication skills.
• Familiarity with third-party payer requirements for both in-network and out-of-network authorization.
• Understanding of authorization processes across various payers.
• Coding certification is a plus but not mandatory.
• Minimum of 3 years of relevant healthcare experience.

Skills:

• Proficient in using personal computers and software applications such as word processing, spreadsheets, and databases.
• Excellent verbal and written communication abilities, with strong organizational skills and an aptitude for prioritizing assignments with minimal oversight.
• Demonstrates professionalism and a collaborative spirit, contributing positively to the team environment.
• Strong critical thinking and clinical judgment skills for effective decision-making.

Knowledge:

• Stay updated on requirements from third-party payers, regulatory agencies, and managed care entities regarding levels of care, continuity of benefits, and medical necessity guidelines.
• Awareness of managed care practices and the latest trends in patient care.

This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidate's qualifications, skills, competencies, and experience and position location. The salary range or rate listed does not include any bonuses/incentive, differential pay or other forms of compensation that may be applicable to this job and it does not include the value of benefits.

At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.