Authorization Specialist

Wagoner Community HospitalWagoner, OK, US

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Job Description

About the Role :

The Authorization Specialist at Wagoner Community Hospital (WCH) plays a critical role in ensuring that patients receive timely and appropriate healthcare services by managing the pre-authorization process with insurance providers. This position is responsible for verifying patient insurance coverage, obtaining necessary approvals for medical procedures, and coordinating with healthcare providers to facilitate seamless patient care. The specialist acts as a liaison between patients, healthcare providers, and insurance companies to resolve any authorization-related issues efficiently. By maintaining accurate records and staying current with insurance policies and regulations, the Authorization Specialist helps minimize delays in treatment and supports the hospital’s operational efficiency. Ultimately, this role contributes to enhancing patient satisfaction and optimizing revenue cycle management within the healthcare setting.

Minimum Qualifications :

High school diploma or equivalent; Associate’s degree in healthcare administration or related field preferred.
Minimum of 2 years experience in healthcare authorization, insurance verification, or medical billing.
Strong knowledge of medical terminology, insurance plans, and healthcare reimbursement processes.
Proficiency with electronic health records (EHR) systems and authorization management software.
Excellent communication and organizational skills with attention to detail.

Preferred Qualifications : .

Experience working in a hospital or clinical setting, particularly within health care services.

Advanced proficiency in Microsoft Office Suite and healthcare information systems.

Demonstrated ability to handle multiple priorities in a fast-paced environment.

Responsibilities :

Review and verify patient insurance information to determine coverage eligibility for requested medical services.

Obtain prior authorizations and approvals from insurance companies for diagnostic tests, procedures, and treatments.

Communicate effectively with healthcare providers, insurance representatives, and patients to clarify authorization requirements and resolve discrepancies.

Maintain detailed and accurate documentation of all authorization requests, approvals, denials, and follow-up actions in the hospital’s information systems.

Monitor authorization status and proactively address any delays or denials to ensure timely delivery of patient care.

Stay informed about changes in insurance policies, payer requirements, and healthcare regulations to ensure compliance.

Collaborate with billing and coding departments to support accurate claims submission and reduce claim denials related to authorization issues.

Skills :

The Authorization Specialist utilizes strong communication skills daily to interact with insurance companies, healthcare providers, and patients, ensuring clear and effective information exchange. Analytical skills are essential for reviewing insurance policies and patient records to determine coverage and authorization requirements accurately. Organizational skills are applied to manage multiple authorization requests simultaneously while maintaining meticulous documentation and tracking. Proficiency with healthcare software and electronic health records enables efficient processing and updating of authorization statuses. Additionally, problem-solving skills are critical when addressing denials or delays, allowing the specialist to find solutions that facilitate timely patient care and support hospital revenue cycles.

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Authorization Specialist • Wagoner, OK, US