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Pre-Authorization SME
IKS Health Coppell, TX

Pre-Authorization SME

IKS Health
Coppell, TX
  • $22 Hourly
  • Vision , Medical , Dental , Life Insurance , Retirement
  • Full-Time
Job Description

Position Overview

The Authorization SME will be responsible for obtaining authorization on critical cases from the Payers for procedures. They will work closely with the offshore team. and will be responsible to coach and provide guidance to them on best practices and issue resolution.

The SME’s will also play integral roles in engaging with new clients, understanding their current state and setting up delivery.

This is a critical function, since patient care depends on the approval of the authorization obtained for the services required.

Job Description

Understanding of the Specialty

  • Thorough understanding of the procedures and diagnosis which requires authorization

  • Interpretation of the medical records

  • Thorough understanding of the treatment protocols of the speciality

  • Understanding of the diagnosis which will be paid as per the speciality nuances

  • Understanding of CPT diagnosis combination

  • Ability to work on more than one client (more EHR)

Understanding of Payer Nuances

  • Detailed authorization submission protocols

  • Skill to get the authorization approved with providing the required information as needed by the Payor

  • Ability to talk with the NP’s if the authorization goes in pending status

  • Understanding of documentation required for obtaining authorization

  • Good understanding of the payor policies

  • Ability to do Peer to Peer with the Payer

Additional Responsibilities

  • Ability to coach new clinical authorization specialists on prior authorization, medical policy reviews and standard workflows

  • Provide ongoing support for existing clinical authorization specialists on new workflows, changes in workflow and general updates or reminders

  • Complete quality improvement and productivity activities

Candidate Profile

Essential:

  • Ability to pass background check and drug test

  • High School Diploma or equivalent or NP

  • Experience in obtaining authorization (including surgeries and procedures)

  • Understanding of EHR systems

  • Hands on experience of handling authorization denials and appeals

  • Strong attention to detail

  • Good verbal and written communication skills

  • Ability to work with Global teams

Desirable:

  • Prior work experience of US healthcare in other functions.

Company Description
About IKS Health

IKS Health is a leading global healthcare company that provides a suite of products and services that help US-based healthcare providers operate more effectively and efficiently. Founded in 2007, IKS has over 5,500 employees, including about 1,000 clinicians, based at our offices in Dallas, Los Angeles, Hyderabad, and Mumbai. We work for 35 large US-based healthcare organizations, including the Massachusetts General Brigham; Mayo Clinic; Beth Israel Lahey; and several of the top-20 health systems in the US. IKS has a collaboration agreement with the prestigious Massachusetts General Hospital’s medical group to develop innovative clinical services that address the needs of US healthcare organizations..

IKS Health offers a Provider Enablement Solution that helps medical groups, health systems, and other ambulatory (i.e. outpatient) healthcare organizations to deliver superior patient care, while ensuring provider delight and financial upsides. Our solutions help healthcare organizations focus on their “core” functions of patient care and provider enablement (i.e. enabling physicians and other providers to take better care of patients), while IKS takes over the “chores” (such as financial, clinical support, and technology processes). We believe IKS is a pioneer in the use of clinical support services using a global delivery model.

About IKS Health IKS Health is a leading global healthcare company that provides a suite of products and services that help US-based healthcare providers operate more effectively and efficiently. Founded in 2007, IKS has over 5,500 employees, including about 1,000 clinicians, based at our offices in Dallas, Los Angeles, Hyderabad, and Mumbai. We work for 35 large US-based healthcare organizations, including the Massachusetts General Brigham; Mayo Clinic; Beth Israel Lahey; and several of the top-20 health systems in the US. IKS has a collaboration agreement with the prestigious Massachusetts General Hospital’s medical group to develop innovative clinical services that address the needs of US healthcare organizations.. IKS Health offers a Provider Enablement Solution that helps medical groups, health systems, and other ambulatory (i.e. outpatient) healthcare organizations to deliver superior patient care, while ensuring provider delight and financial upsides. Our solutions help healthcare organizations focus on their “core” functions of patient care and provider enablement (i.e. enabling physicians and other providers to take better care of patients), while IKS takes over the “chores” (such as financial, clinical support, and technology processes). We believe IKS is a pioneer in the use of clinical support services using a global delivery model.

Address

IKS Health

8951 Cypress Waters Blvd

Coppell, TX
USA

Industry

Education

Posted date

Over a month ago

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IKS Health job posting for a Pre-Authorization SME in Coppell, TX with a salary of $22 Hourly and benefits including vision, 401k, dental, life_insurance, and medical with a map of Coppell location.