Job Details

Authorization Specialist (Remote in Wisconsin & Michigan)

Come work at a place where innovation and teamwork come together to support the most exciting missions in the world! Wisconsin and Michigan residents only eligible to apply.

Job Summary: The Authorization Specialist is a healthcare professional responsible for reviewing patient medical records to determine if a prescribed treatment, procedure, or medication requires prior authorization from the insurance company, ensuring that the requested care is deemed medically necessary and covered under the patient's benefits before it can be administered; this involves verifying patient eligibility, contacting insurance companies to obtain authorization, and managing the process to minimize delays in patient care. An Authorization Specialist works in a fast-paced environment with high call volumes, requiring strong organizational skills and the ability to manage multiple tasks simultaneously.

Job Qualifications:

Education: For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation.

Minimum Required: None

Preferred/Optional: Successful completion of post-secondary courses in Medical Terminology and Diagnosis and CPT Coding, and Anatomy & Physiology. Graduate of a Medical Assistant, Health Unit Coordinator or Health Care Business Service program.

Experience:

Minimum Required: Two years' experience in a medical business office or health care setting involving customer service or patient-facing responsibilities, or equivalent experience.

In addition to the following:

• Medical knowledge: Understanding of basic medical terminology, disease processes, and treatment options to accurately assess medical necessity.
• Insurance knowledge: Familiarity with different insurance plans, benefit structures, and prior authorization guidelines.
• Excellent communication skills: Ability to effectively communicate with healthcare providers, insurance companies, and patients to clarify information and address concerns.
• Attention to detail: High level of accuracy in data entry and review of medical records to ensure correct prior authorization requests.
• Problem-solving skills: Ability to identify potential issues with prior authorization requests, navigate complex situations, and find solutions to ensure timely patient care.

Certifications/Licenses: The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position.

Minimum Required: None.

Preferred/Optional: None.

Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first.

Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System's Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program.

Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.