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We are seeking a Clinical Authorization Specialist:
Confirm the need for authorizations by taking the appropriate actions to ensure authorizations are obtained; this includes acting as a liaison between insurance companies, healthcare providers and patients in coordinating the prior authorization of surgeries performed at performed at UWHC, TAC, MSC, and Meriter Hospital
Medical Policy Review to ensure scheduled procedures will meet medical necessity guidelines set forth by insurance payers
Coordinate with, educate and advise providers participating in a patients care regarding complex or high-risk admissions, or any episode of service requiring additional attention Education:
Minimum – High School diploma or equivalent and completion of a Medical Assistant program, or licensure as an LPN
Preferred – Graduate of School of Nursing
Minimum – Two years clinical experience and one year preadmission/precertification experience
Licenses and Certifications:
Minimum – Certified Medical Assistant or Licensed Practical Nurse
Preferred – Registration as a professional nurse in the State of Wisconsin
Required Skills, Knowledge, and Abilities:
Maintains current knowledge of medical modalities as well as new protocols established for patient populations.
Solid understanding and knowledge of payer contractual requirements, registration workflows, and prior authorization requirements to ensure staff follow established procedures to maximize reimbursement and minimize write offs.
Excellent written and oral communication skills.
Maintains effective and cooperative working relationships with co-workers, leaders, clinical staff and the public.
Must be detail oriented and accurate.
Ability to multi-task and prioritize tasks.
Displays an aptitude and willingness to learn new responsibilities.
Willingly accepts feedback.
Flexible and innovative.
Ability to problem-solve and work independently.
Displays a professional appearance.
Dependable and reliable in achieving goals.
Experience operating office machines such as personal computers, fax machines, photocopier, and document scanners.
Familiarity with medical terminology and abbreviations. Physical Requirements:
Sedentary: Ability to lift up to 10 pounds maximum and occasionally lifting and/or carrying such articles as dockets, ledgers and small tools. Although a sedentary job is defined as one, which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.
This is a full-time, 1.0 FTE position that is scheduled to work Monday through Friday, 8:30 am – 5:00 pm. Hours may vary based upon the operational needs of the department.
UW Health Administrative Facilities – UW Health has administrative locations throughout Madison and beyond where thousands of employees provide vital support to our clinical areas. These locations are home to departments such as Access Services, Compliance, Human Resources, Information Services, Patient Medical Records, Payroll and many others.
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UW Hospital and Clinics benefits
UW Health values and embraces diversity and is proud to be an Equal Employment Opportunity, Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability
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