Revenue Authorization Specialist II

Employment Type:

Full time

Shift:

Day Shift

Description:

Responsible for all aspects of the authorization/pre-certification, referral process and identifies
amendments/retros to help maximize revenue for departments when CPT (Current Procedural
Technology) codes for technologies and services change. Assists in maintaining charge review
and claim edit registration work queues and identifying trends to optimize workflows/education
needed.

ESSENTIAL FUNCTIONS 1. Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions. Contacts insurance companies via appropriate methods and obtains pre-certifications and authorizations.

1. Obtains urgent authorizations same day, next day.
2. Verifies correct procedural and diagnostic codes and insurance verification.
3. Monitors in basket, email, and fax server if applicable. Follows up on correspondence timely and accurately.
4. Monitors authorizations or denials and follows up, as necessary.
5. Generates authorization information for physicians, patients, and health plans.
6. Obtains pre-certifications, insurance, and testing authorizations for medical procedures.
7. Communicates denials to appropriate staff and next steps.
8. Acts as a liaison among providers, staff, health plan administrators and hospital representatives.
9. Relays clinical information to health plan case managers for special procedure precertification and out-of-plan or out-of-network referrals; monitors authorizations or denials and follows up, as necessary.
10. Communicates referral status to staff and physicians; ensures that authorizations have been processed accurately and in a timely manner to coincide with patient treatment plan.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.