Authorization Specialist
Company: Evolent Health
Location: Albany
Posted on: March 19, 2023
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Job Description:
**Your Future Evolves Here**New Century Health (NCH) has been
transforming the delivery of specialty care and driving radical
cost and quality improvement across the member journey for patients
with cancer and cardiovascular disease. As part of Evolent Health,
we are on a bold mission to change the health of the nation by
changing the way health care is delivered. Evolenteers make a
difference wherever they are, whether it is at a medical center, in
the office, or while working from home across 48 states. We empower
you to work from where you work best, which makes juggling careers,
families, and social lives so much easier. Through our recognition
programs, we also highlight employees who live our values, give
back to our communities each year, and are champions for bringing
their whole selves to work each day. If you're looking for a place
where your work can be personally and professionally rewarding,
don't just join a company with a mission. Join a mission with a
company behind it.**Why We're Worth the Application:**+ We continue
to grow year over year.+ Recognized as a leader in driving
important diversity, equity, and inclusion (DE&I) efforts
(https://www.evolenthealth.com/diversity) .+ Achieved a 100% score
two years in a row on the Human Rights Campaign's Corporate
Equality Index recognizing us as a best place to work for LGBTQ+
equality.+ Named to Parity.org's list of the best companies for
women to advance for 3 years in a row
(https://www.evolenthealth.com/about-us/press-releases/9328/evolent-health-named-to-parity.org%E2%80%99s-best-companies-for-women-to-advance-list-2022)
(2020, 2021 and 2022).+ Continue to prioritize the employee
experience and achieved a 90% overall engagement score on our
employee survey in May 2022.+ Publish an annual DE&I report
(https://dev.evolenthealth.com/sites/default/files-public/Evolent%20Health%202020%20DE%26I%20Annual%20Report.pdf)
to share our progress on how we're building an equitable
workplace.**What You'll Be Doing:**Responsible for verifying
patient benefits for medical claim approval including obtaining
prior-authorization and pre-certification when necessary. Adheres
to department policies and procedures and complies with performance
standards to ensure risk determinations and contract requirements
are managed effectively. These activities are to be performed in
compliance with federal, state and local laws as well as corporate
policy. These individual projects a professional appearance and
customer friendly demeanor at all times while maintaining the
confidentiality of patient, coworker and facility information. This
position at times works under stress and in situations that demand
patience while providing impeccable service to all
customers.Essential Duties and Responsibilities+ Prioritizes
incoming prior-authorization and pre-certification requests as
outlined in departmental policies, procedures, and workflow
guidelines.+ Contacts the health plan to gain plan information,
verify active coverage, obtain all plan benefits as well as
authorization requirements+ Communicates efficiently and
professionally directly with facility or Account Management team to
acquire all necessary documentation for case decisioning as well as
provides this information to the health plans to ensure all
requirements are met for authorization.+ Follows up timely and
within department guidelines on all cases that are pending
information and escalates cases as necessary if help is needed to
obtain documentation.+ Receives inbound and makes outbound calls to
healthcare professionals, commercial and workers' comp carriers,
and manufacturer sales representatives.+ Makes accurate,
appropriate and timely case notes and database entries to ensure
accurate and detailed case information.+ Refers requests that
require clinical judgment to Underwriter Supervisor.+ Meets
position metrics and turn-around timeframes using reports provided
while maintaining a full caseload.+ Maintains strictest
confidentiality; adheres to all HIPAA
guidelines/regulations.Education And/or Experience+ Previous health
plan experience required.+ Two-year degree preferred or equivalent
experience and job knowledge.+ Knowledge of medical terminology and
coding.+ Excellent computer skills in Excel and Word.+ High level
of attention to detail.+ Excellent organizational skills and
communication skills.+ Requires at least one year of experience
working prior-authorizations approvals with insurance companies.+
Experience conducting general carrier research and communicate
discovered information timely to Underwriter Supervisor.+ Ability
to work quickly and accurately on an independent basis with great
attention to detail, and displaying initiative to quickly identify
and resolve variances and discrepancies.+ Strong problem solver and
skilled in conflict resolution.+ Strong computer literacy.+ Works
well in a team environment.**Technical Requirements:**Currently,
Evolent employees work remotely temporarily due to COVID-19. As
such, we require that all employees have the following technical
capability at their home: High speed internet over 10 Mbps, the
ability to plug in directly to the home internet router. These
at-home technical requirements are subject to change with any
scheduled re-opening of our office locations.Evolent Health is
committed to the safety and wellbeing of all its employees,
partners and patients and complies with all applicable local,
state, and national law regarding COVID health and vaccination
requirements. Evolent expects all employees to also comply. We
currently require all employees who may voluntarily return to our
Evolent offices to be vaccinated and invite all employees
regardless of vaccination status to remain working from
home.**Evolent Health is an equal opportunity employer and
considers all qualified applicants equally without regard to race,
color, religion, sex, sexual orientation, gender identity, national
origin, veteran status, or disability status.**Compensation Range:
The minimum salary for this position is $25/hr, plus benefits.
Salaries are determined by the skill set required for the position
and commensurate with experience and may vary above and below the
stated amounts.Don't see the dream job you are looking for? Drop
off your contact information and resume and we will reach out to
you if we find the perfect fit!For more insights about Evolent
Health, click on Life At Evolent
(https://www.evolenthealth.com/about-us/life-at-evolent) to learn
more!
Keywords: Evolent Health, Albany , Authorization Specialist, Other , Albany, New York
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