Job Description

Work for One of the Worlds Best Hospitals!

For Three Consecutive Years, Newsweek named Southcoast Health among the Worlds Best Hospitals (Charlton Memorial, St. Lukes, and Tobey). In addition, since 2018, Southcoast Health has been voted by readers as South Coast Media Groups Best Place to Work. Why? Because we have some of the most talented people in the world!

We are searching for a -Surgery-Ancillary Authorization Specialist to perform a wide variety of duties to secure optimal revenue for all services performed at Southcoast facilities. Enter orders, schedule/cancel/reschedule appointments, determine patient liability prior to service by creating estimate based on individual payer, notify patients of their potential liability in accordance with Federal & State regulations and collect payment electronically. Initiate contact w/patients, physicians, third party payers to obtain pre-certification and authorization for all inpatient and outpatient services. Liaison between third party payers and providers, coordinate peer to peer discussions to authorize surgical and high dollar services. Use critical thinking skills to ensure CPT codes are documented and authorized for appropriate services. Partner with Care Coordination to determine and authorize appropriate level of care. Navigate multiple payer portals to determine requirements for authorization and submit electronic requests. Work with Pharmacy to determine appropriate infusion medication source and obtain authorization for medication/services. Follow-up with payer denials by researching clinical data to support an appeal. Verify coverage and initiate authorization for new patients to be accepted to SE Rehab Department.

• Hours: 40 hours per week
• Shift: Day shift with weekend and holiday rotation; 8:30am-5:00pm; Required to work one minor Holiday per year
• Location: Southcoast Business Center, Fairhaven, MA - Office is a cube style environment with no direct patient contact

Education and/or Experience Requirements:

• Associates Degree in a related field or equivalent combination of education and experience is required; Bachelors Degree preferred.
• Certificate in Medical Terminology is preferred.
• Coding experience is preferred.
• Strong keyboard skills with the ability to type 40 words per minute.
• Proven exceptional customer service skills.
• Ability to communicate with physicians, patients and third-party payers.
• Proficient with navigating multiple payer portals and web-based tools.
• Over three years of healthcare experience focusing on revenue cycle activities is preferred.
• Excellent attendance required.

Must be fully vaccinated against seasonal Influenza and the COVID 19 virus and provide required vaccination documentation unless approved for an exemption or deferral by Southcoast prior to starting employment.

Southcoast Health is a community healthcare system with multiple access points, offering an integrated continuum of health services throughout Southeastern Massachusetts and Rhode Island. By uniting a single purpose and building an integrated system of services and resources, we have become one of the largest and fastest-growing health systems in Massachusetts.

Together We Are More.

• With more than 7,500 employees, Southcoast Health is the largest employer in Southeastern Mass., and the 18th largest employer in the Commonwealth, according to the Boston Business Journal.
• We strive for a culture of health and well-being that recognizes, respects, and celebrates the rich diversity of one another and the communities we serve.

We are committed to providing our employees in Massachusetts and Rhode Island with optimal benefits that promote a healthy work/life balance and add value to our employees lives.

• Generous Earned Time Off Package**
• Health, Dental and Vision Insurance*
• Tuition Assistance**
• Short Term and Long-Term Disability Insurance*
• Life & AD&D insurance*
• Flexible Spending Accounts*
• 403B Retirement Plan with match
• HealthQuest Wellness Program
• Employee Assistance Program
• Employee Discount Program
• Career Development Opportunities
• Diversity, Equity and Inclusion Council

*Available to regular status employees who are scheduled to work a minimum of 24 hours.

**Available to regular status employees who are scheduled to work a minimum of 20 hours.

Are you ready to make a difference in your community? Join us to be More than Medicine!

Southcoast Health is an Equal Opportunity Employer

Southcoast Health System