What are the responsibilities and job description for the Authorization Specialist position at Hopco?
Healthcare Outcomes Performance Company is a vertically integrated musculoskeletal outcomes management company. HOPCo manages physician practices, hospital service lines, population health and value-based care programs, and musculoskeletal delivery networks.
HOPCo is the managing partner of Arizona-based entities, CORE Institute, Northern Arizona Orthopaedics, CORE Institute Specialty Hospital, Michigan-based CORE Institute, and Florida-based Southeast Orthopedic Specialists.
At The CORE Institute, we are dedicated to taking care of you so you can take care of business! Our robust benefits package includes the following:
- Competitive Health & Welfare Benefits
- Monthly $43 stipend to use toward ancillary benefits
- HSA with qualifying HDHP plans with company match
- 401k plan after 6 months of service with company match (Part-time employees included)
- Employee Assistance Program that is available 24/7 to provide support
- Employee Appreciation Days
- Employee Wellness Events
As HOPCo continues to grow, we are looking for an Authorization Specialist in our Corporate Headquarters.
Please see below for the functions and requirements to be an Authorization Specialist with HOPCo.
ESSENTIAL FUNCTIONS
- Monitors the authorizations of upcoming surgical cases on the physician’s calendars ensuring authorizations for surgeries are obtained in a timely and accurate manor.
- Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms necessary information to allow processing of claims to insurance plans.
- Accurately completes surgical cost analysis form, documenting the required surgical cost estimation for collection prior to services.
- Verifies benefits on all surgical procedures.
- Document’s authorizations and progress of authorizations in the patient’s chart. Enters the authorization information within case management.
- Must be able to communicate effectively with physicians, patients, and co-workers and be capable of establishing good working relationships with both internal and external customers.
- Participate in providing ongoing training and education of staff as it relates to new processes to ensure timely confirmation of surgical cases.
- Work with department manager to respond to and reduce complaints timely and professionally.
- Assist surgery schedulers with STAT authorizations.
- Ensure strict confidentiality of all health records, member information and meet HIPAA guidelines.
EDUCATION
- High school diploma/GED or equivalent working knowledge preferred
EXPERIENCE
- Minimum of 2 years’ experience in healthcare field is required and previous experience in referrals/authorizations, front office, and/or charge posting is preferred. Excellent organizational skills and strong customer service orientation are required with strong background with computers and data entry.
KNOWLEDGE
- Working knowledge of eligibility, verification of benefits, and prior authorizations from various HMOs, PPOs, commercial payers and other funding sources.
- Federal, state and HIPAA privacy regulations.
- Knowledge of computer applications.
SKILLS
- Skill in effective organization and billing requirements and authorization processes.
- Skill in using computer programs and applications including Microsoft Excel, Microsoft Word and Outlook
- Skill in establishing good working relationships with both internal and external customers.
ABILITIES
- Ability to multi task in a fast-paced environment. Must be detailed oriented with strong organizational skills.
- Ability to understand patient demographic information and determine insurance eligibility.
- Ability to work independently and demonstrate the ability to analyze data.
- Ability to communicate effectively and compassionately with patients, co-workers, management, and providers.
The CORE Institute team is dedicated to making the lives of others better by practicing exceptional patient care. If you would like to be part of a dedicated, dynamic healthcare team in a challenging, rewarding environment, The CORE Institute is the right place for you to grow your career.
