Authorization Specialist II

Department/Unit:

Work Shift:

Salary Range:

• Responsible for financial clearance of scheduled services for Hospital Surgical (Inpatient and Outpatient) and Clinic appointments, assuring no delay in payment of claim.
• Precept new team members for successful onboarding to the Authorization Specialist I position.
• Ability to identify authorization needs including but not limited to Out of Network management of appointments and encounters.
• Responsible to interpret information received from Insurance Payer regarding patient’s eligibility and financial responsibility
• Responsible to discuss financial obligation to patient, if required.
• Ability to accurately interpret referral/physician order to meet the patient and/or provider need for scheduling of services correctly including multi-scheduling needs for related services
• Responsible for scanning or managing online form template to maintain the Electronic Health Record
• Comprehend Federal, State, Third Party Payer regulations as it pertains to a hospital and practice pre-registration.
• Excellent knowledge of third- party payer authorization portals; authorization guidelines by payer and critical detail to follow up.
• Responsible for review of services being rendered to ensure the appropriate setting of care has been assigned by the physician’s office
• Obtains all insurance information from patient and verifies insurance to ensure active coverage for services being scheduling and obtains authorization via portal, fax and telephone.
• Provides thorough comments, where applicable for all conversations with patients or providers.
• Ability to organize work with multiple steps to ensure no scheduling or authorization needs are missed.

• Associate's Degree - required
• Bachelor's Degree - preferred
• 3 – 5 years’ experience in Hospital or Physician office experience or call center environment, - preferred
• Strong insurance knowledge specific to complex scheduling needs and authorization management
• Ability to precept new team members
• Proven customer service skill with ability to exceed expectations
• Demonstrated knowledge payer authorization requirements
• Strong attention to detail
• Ability to multi-task in stressful and high patient volume unit
• Must be able to manage pressure of very tight timeframes to execute task
• Ability to learn in classroom, utilizing resources
• Ability to remain composure under pressure
• Ability to train and onboard colleague
• Ability to review information and draw appropriate conclusion
• Good judgement and ability to be resourceful to problem solve; escalate issues as needed
• Team minded worth ethic
• Demonstrated ability interpret patient’s insurance benefits and apply the applicable contractual obligations
• Critical thinking ability regarding issues with financially securing payment
• CHAA (or acquired within 2 years of hire) - required
• Learning Partner Module

• Standing - Occasionally
• Walking - Occasionally
• Sitting - Constantly
• Talking - Frequently
• Hearing - Frequently
• Repetitive Motions - Frequently

Thank you for your interest in Albany Med Health System!​

Albany Med Health System is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Med Health System, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:

Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Health System policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.