Authorization Specialist - Dermatology

About the Role

As part of VillageMD's network, the Authorization Specialist contributes to the company's mission of simplifying healthcare and providing connected, patient-centric care. This involves working closely with various teams, including the Reimbursement Department, to ensure timely and accurate processing of authorizations and referrals.

The Authorization Specialist role is integral to ensuring that patients receive the necessary care without unnecessary delays or denials. This requires not only a keen understanding of insurance carrier guidelines and clinical policies but also the ability to navigate complex systems and digital tools efficiently.

What You Will Do

• Identify all appointments and procedures requiring authorization by monitoring schedules, system reports, and dashboards.
• Determine referral and authorization requirements based on patients' insurance plans, using online resources according to department workflows.
• Demonstrate knowledge of insurance carrier guidelines, clinical policies, and state guidelines related to referrals and prior authorization.
• Verify insurance eligibility and benefits, updating patient insurance information as necessary.
• Complete referrals and prior authorizations in a timely manner, adhering to department guidelines and workflows.
• Communicate clearly and effectively with patients, physicians, office staff, and managers to resolve issues that may result in denied or delayed authorization requests.
• Utilize system knowledge to run reports, document and manage referrals and authorizations, move correspondence, resolve eligibility and authorization holds, and perform other system tasks within security access.
• Request, prepare, and recognize the documentation required to support medical necessity for authorized services.
• Provide immediate feedback to supervisors and managers on issues affecting workflow, reimbursement, and customer service.
• Ensure accurate information entry into patient accounts.
• Collaborate with the Reimbursement Department to minimize denials and ensure proper reimbursement.
• Work with team members to meet department deadlines and benchmarks.
• Anticipate and perform necessary job duties, maintaining patient confidentiality.

What We Are Looking For

• 2+ years of experience in an authorization or related role within a healthcare setting.
• Strong understanding of medical insurance, including knowledge of clinical policies and state guidelines.
• Excellent communication and interpersonal skills, with the ability to work with patients, physicians, and other stakeholders effectively.
• Proficiency in electronic health records (EHRs) and other digital tools.
• Ability to work in a fast-paced environment, prioritizing tasks and managing multiple projects simultaneously.
• Strong analytical and problem-solving skills, with attention to detail.
• High school diploma or equivalent required; post-secondary education in a healthcare-related field preferred.
• Experience with Epic or similar EHR systems is beneficial.
• Certification in medical billing or a related field is a plus.

Nice to Have

• Experience working in dermatology or a similar specialty.
• Knowledge of value-based care principles and their application in a clinical setting.
• Familiarity with population health management strategies.
• Bilingual or multilingual skills, depending on the patient population served.

Benefits and Perks

• Competitive salary and benefits package.
• Opportunity to work with a physician-led, patient-centric network committed to innovating healthcare.
• Remote work options, providing flexibility and work-life balance.
• Professional development and growth opportunities within a dynamic and expanding company.
• Access to cutting-edge technology and digital tools.
• Collaborative and supportive team environment.
• Recognition and reward for outstanding performance and contributions.
• Comprehensive health insurance, including medical, dental, and vision coverage.
• 401(k) or similar retirement plan with company match.
• Generous paid time off (PTO) and holiday schedule.
• Flexible spending accounts (FSAs) for healthcare and dependent care.

• Develop a strong foundation in medical terminology and insurance billing principles to stand out in this role.
• Familiarize yourself with Epic or similar EHR systems to improve your chances of success.
• Highlight any experience working in dermatology or with value-based care models in your application.
• Prepare examples of times when you've effectively communicated with patients and healthcare providers to resolve issues.
• Consider obtaining certifications in medical billing or related fields to enhance your application.
• Be ready to discuss strategies for managing complex workflows and prioritizing tasks in a fast-paced environment.
• Research VillageMD's approach to connected care and be prepared to discuss how your skills and experience align with their mission.