Call Center Authorization/Quality Specialist – Apply Now!

Are you ready to make an impact in the healthcare industry? Capital Health, a leader in providing exceptional patient care, is looking for a Call Center Authorization/Quality Specialist to join their team. In this role, you will play a crucial part in ensuring outpatient testing services are authorized efficiently, ensuring accurate data, and supporting the medical office with vital operational tasks.

As part of the team, you’ll help improve patient care by working directly with insurance providers, ensuring the smooth authorization of services, and maintaining high-quality standards for all scheduled tests. If you have a background in insurance verification, scheduling, and a passion for quality patient care, this is your opportunity to be part of a prestigious and growing healthcare institution.

Key Responsibilities:

✅ Authorization and Pre-Certification

• Secure insurance authorizations and pre-certifications for outpatient services.
• Verify pre-certifications to ensure appropriate reimbursement and process billing accurately.
• Work closely with physicians’ offices to obtain all required information for authorizations.
• Maintain up-to-date knowledge of insurance plans, pre-registration compliance, and industry best practices.

✅ Quality Auditing and Process Improvement

• Review charts for completeness, ensuring all required information (demographic, diagnosis, insurance) is accurate.
• Identify any quality gaps or discrepancies and propose improvements.
• Ensure compliance with regulatory and licensing standards to avoid claim denials.
• Communicate findings and work collaboratively with the management team to improve service quality.

✅ Customer Service & Communication

• Handle patient and physician inquiries effectively, ensuring clear communication and resolution of issues.
• Assist in handling insurance discrepancies and claim rejections, ensuring that all necessary information is provided promptly.
• Provide feedback to patients and staff about missing information, ensuring smooth pre-registration and scheduling.

✅ Administrative Support

• Perform chart reviews to ensure proper documentation and avoid errors in billing.
• Utilize various systems like On-Base, Cerner, and other tools to manage scheduling and pre-certification functions.
• Maintain up-to-date records of insurance verification, authorizations, and referrals in the scheduling system.

Minimum Requirements:

✔ Education:

• High school diploma or GED required. A related field qualification in healthcare or insurance would be beneficial.

✔ Experience:

• At least 5 years of experience in patient scheduling, medical office roles, or insurance verification.
• Previous experience with insurance portals like Experian, Navinet, and related systems is preferred.

✔ Skills & Knowledge:

• Strong working knowledge of medical insurance plans and basic medical terminology.
• Proficiency in insurance applications and payor codes for accurate authorization processes.
• Excellent communication skills, both verbal and written, to interact effectively with patients and staff.

Preferred Skills:

🌟 Problem-Solving Skills: Ability to identify issues and propose actionable solutions for process improvements.
🌟 Attention to Detail: Ensure all patient information is accurate and meet quality standards.
🌟 Patient Relations: Strong skills in maintaining professionalism and empathy when interacting with patients and physicians.
🌟 Familiarity with Health IT Systems: Experience with On-Base, Cerner, and Gaffey systems is an advantage.

Why Join Capital Health?

Capital Health is renowned for its excellence in patient care and nursing standards. Joining our team means being part of a prestigious, Magnet-recognized healthcare system where your contributions are valued. As part of our team, you’ll have access to:

• Competitive Compensation and Benefits: Including healthcare, retirement plans, and paid time off.
• Career Growth Opportunities: Access to continuous training and career development programs.
• Supportive Work Environment: Work alongside a team of experts dedicated to quality care and continuous improvement.

If you’re looking for a challenging and rewarding role in healthcare with ample opportunities for growth and development, apply now for the Call Center Authorization/Quality Specialist position!

How to Apply:

Submit your application now to become part of the Capital Health team. We look forward to your contribution to enhancing patient care through high-quality service and operational efficiency.

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TIPS for CV Related to this Post:

When applying for the Call Center Authorization/Quality Specialist position, make sure your CV includes the following:

• Relevant Experience: Highlight your previous roles in medical office management, patient scheduling, or insurance verification.
• Insurance Knowledge: Emphasize any experience with insurance verification, pre-certification, or authorizations.
• Medical Terminology: Show that you understand basic medical terms and diagnosis codes.
• Technological Proficiency: Include experience with systems like On-Base, Cerner, or Experian.
• Attention to Detail: Demonstrate examples where you’ve maintained accuracy in handling medical and insurance data.

Good luck with your application! We look forward to reviewing your qualifications and discussing how you can contribute to improving patient care with Capital Health.