At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day.

                        

We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One.

                                    

Job TitleAuthorization Specialist-1

                        

LocationCleveland

                    

FacilityRemote Location

                     

DepartmentRCM Pre Access-Finance

                      

Job Code000784

                     

ShiftDay/Evening/Night/Weekend

                       

Schedule8:30am-5:00pm

                       

Job SummaryVerification of patient's insurance and securing authorizations/referrals for Radiology, physician and surgical procedures.

                         

Job Details

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.    

 
In our Finance division, caregivers use their knowledge and skills every day to provide exceptional experiences for patients and their families in a variety of diverse functions. Through the talents of over 2,500 dedicated caregivers, our Revenue Cycle Management supports the Cleveland Clinic mission by securing timely, appropriate payment for services rendered, efficiently patient-friendly. This role is a strong introduction to future growth within the department, including Representative Level II and III, Administrative Program, Quality Assurance and Program Manager positions, and formal leader roles such as Work Leader, Supervisor, Manager and Senior Manager. 

This is a remote position open to Florida residents only.

Responsibilities:

Verifies patient insurance eligibility and benefits by means of Internet resources or manually procuring information from the insurance carrier.Conveys information regarding procedure codes and diagnostic codes in order to receive correct referrals for office visits and authorization for inpatient and outpatient hospital procedures.Communicates and coordinates with interdepartmental and interoffice personnel to procure correct and detailed information regarding all referrals and authorizations.Updates and informs all parties involved of any insurance or procedural changes regarding authorizations or office visit referrals.Obtains all referrals and authorizations for office visits and procedure and hospital in patient/out patient procedures same day.Other duties as assigned.

Education:

High School Diploma, college or technical training a plus.Phone, Typing computer and Internet skills.Excellent interpersonal skills in order to communicate effectively with internal and external personnel and strong oral and written communication skills.Must be able to work with patients, physicians and interoffice personnel in a positive and productive manner.Ability to calm patients and deter patient complaints.Must have ability to multi-task.

Certifications:

None required.

Complexity of Work:

All employees are expected to meet the standards of performance outlined in the Organizational-Wide Competencies listed below as applied to the position:World Class Service Orientation: Includes attitude, behavior, interpersonal skill, and problem solving that enable an employee to respond to internal and external customer needs and expectations in a positive manner.Adaptability: Includes teamwork and flexibility needed to fulfill job responsibilities including adapting to changes in work environment and accepting supervisory feedback.Efficiency and Effectiveness: Includes quantity and quality of desired work, as well as organization skills necessary to perform successfully.Essential Job Requirements: Includes adherence to all relevant policies, procedures, and guidelines affecting the work environment, including maintenance of required competencies and communication skills.Supervisory Responsibilities (if applicable): Includes overall accountability for assigned work group relative to operational goals, personnel requirements, and budgetary constraints.Note: The above stated duties are intended to outline those functions typically performed by individuals assigned to this classification. This description of duties is not intended to be all inclusive nor to limit the discretionary authority of supervisors to assign other tasks of similar nature or level of responsibility.

Work Experience:

Minimum of two (2) years experience in the medical field.Working knowledge of office referrals and surgical and hospital authorization procedures.

Physical Requirements:

Essential Duties: Able to relate to other health care workers and develop productive work relationships with peers and physicians. Projects a cooperative helping demeanor. Be able to perform under stressful conditions. Is flexible and able to adjust to changes in assignments. Able to work under minimal supervision, prioritizes workload and meet required deadlines.Physical Duties: Ability to sit for long periods of time, work in front of a computer monitor and use keyboard for sustained periods of time. Must be able to walk about the department and lift and carry paper, notebooks up to 10 pounds without assistant.Working Conditions: The occupant of this position spends almost 100% of his/her time in air-conditioned areas. The potential for exposure to blood-borne pathogens, body fluids or potentially infectious material is minimal to none.

Personal Protective Equipment:

Follows Standard Precautions using personal protective equipment as required for procedures. 

                       

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. All offers of employment are follwed by testing for controlled substances and nicotine. All new caregivers must clear a nicotine test within their 90-day new hire period. Candidates for employment who are impacted by Cleveland Clinic Health System's Smoking Policy will be permitted to reapply for open positions after one year.

Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.

Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility. 

Please review the Equal Employment Opportunity poster. 

                  

Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities