Medical Authorization Specialist

medical authorization specialist

Location: Remote

Department: Customer Experience

Job Type: Full-Time

Shift: Monday- Friday, 8:15 a.m.-5:00 p.m. (ET)

Clinical Classification: Non-Clinical

LifeNet Health is searching for talented individuals who will embrace our mission of saving lives, restoring health, and giving hope.

LifeNet Health, headquartered in Virginia Beach, Virginia, is the largest nonprofit organ procurement organization (“OPO”) and tissue processor in the United States, as well as a leading innovator in tissue engineering and regenerative medicine. Our goal is to improve the quality of human life through the provision of organs, tissues, and cells for transplantation; to provide innovation in the fields of bio-implants, regenerative medicine and research; and, to serve the community with educational and support services that enhance the donation process.  LifeNet Health has over 1200 employees and has a growing global presence.

How you will contribute to LifeNet Health’s success:

The Medical Authorization Specialist supports LifeNet Health’s reimbursement strategy by handling verification of insurance benefits and authorizations to ensure appropriate patient access to care. The role also serves as a subject matter expert for both our Sales and Marketing teams, as well as relevant insurance companies.

What you’ll do:

• Patient Authorization: Reviews and interprets medical record documentation for patient history, diagnosis, and previous treatment plans. Utilizes payer-specific approved criteria to determine medical necessity or the clinical appropriateness for the company’s products. Submits pertinent demographic and supporting clinical documentation with authorization requests timely to avoid unnecessary delays in patient treatment.
• Documentation: Maintains and documents complete, timely, and accurate case information, including Protected Health Information (PHI). Maintains patient records to ensure delivery against individual and department metrics.
• Policy Interpretation: Responsible for identifying medical insurance policies, interpreting coverage, and providing diagnosis coding based on company products.
• Patient Liaison: Works with external customers to secure any additional information and medical documentation from the patient and/or prescribing health care provider.

What you’ll bring (Minimum Requirements):

• High school diploma or GED
• One (1) year of experience with insurance verification or medical authorization experience involving medical record review.
• Experience managing Protected Health Information (PHI).

These would be nice too (Knowledge Skills and Abilities):

• Communication Skills: Excellent verbal and written communication skills; ability to communicate and build relationships with all professionals at different levels within the organization.

• Time Management: Ability to prioritize multiple, competing priorities and manage time/workload. Demonstrated ability to effectively prioritize and juggle multiple time sensitive projects, multi-task, identify project interdependencies and potential risks/pitfalls.
• Attention to Detail: Ability to perform tasks thoroughly and with care; checks work to ensure high degree of accuracy/completeness and early/on-time delivery.
• Proficiency in Microsoft Office: PowerPoint, Excel, Word, Outlook, Microsoft Suite.
• Medical Terminology and ICD-10 Coding: Knowledge of and interpretation skills.

Why work at LifeNet Health?

We have a fierce drive for our mission of Saving Lives, Restoring Health, and Giving Hope. You will not find another company with a culture as strong as ours.

• 403(b) and Profit-Sharing Plan
• Affordable medical, dental, and vision coverage
• Corporate sponsored events for employees
• Work-life balance with generous paid time off to include vacation time, sick time, and paid holidays
  • 18 vacation days
  • 9 sick days
  • 7 paid holidays
• Tuition reimbursement
• Personal career, skill, and leadership development opportunities
• Wellness Program (gym reimbursement, monthly wellness webinars, mental health toolkit, financial resources, and much more)
• Employee Assistance Program (EAP) for employees and members of their household
• Dedicated and passionate co-worker

Salary: $16.83-$22.44/ hour

The pay rate for the successful candidate will depend on geographic location and the candidate’s qualifications and prior relevant experience. The pay range for this position is $16.83 hourly (entry-level qualifications) to $22.44 hourly (experienced in this role).

* Actual compensation may be higher based on the successful candidate's knowledge and relevant experience.

This position is eligible for an annual bonus once eligibility criteria are met. 

All benefits are subject to eligibility requirements and LifeNet Health reserves the right to modify or change these benefits programs at any time, with or without notice, unless otherwise required by law.  Further, nothing in this posting is intended to alter the “at will” relationship of a successful candidate and this posting does not constitute a specific promise.

LifeNet Health is an equal opportunity employer. All qualified candidates will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected status.  We maintain a drug-free workplace and perform pre-employment substance abuse testing.