Authorization Specialist

Company: Evolent Health
Location: Sacramento
Posted on: March 18, 2023

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, Sacramento , Authorization Specialist, Other , Sacramento, California