Title: Authorization Specialist Location: US:OH:Akron Administrative Full Time Summary: The Authorization Specialist is responsible for obtaining prior authorizations and verifying insurance coverage for pediatric patients. This includes therapy, behavioral health, diagnostic procedures, specialist visits, surgeries, injections, infusion therapies, and advanced radiology services (CT, MRI, PET, and Nuclear Medicine). The specialist plays a critical role in ensuring timely access to care, supporting families in navigating the insurance process, and helping minimize financial barriers to treatment. Responsibilities: - Secure prior authorizations for a variety of pediatric services. - Verify insurance eligibility and benefits prior to service; ensure benefits and authorizations are clearly documented in the patient record. - Gather, verify, and review the necessary clinical documentation from providers, including medical records, progress notes, lab results, treatment plans, and any other require information to ensure requested services meeting payer medical necessity requirements based on CPT codes provided. - Coordinate with clinical and scheduling teams to prevent delays in care caused by pending or denied authorizations. - Participate in clinical huddles and team meetings to discuss challenges, share best practices, and contribute to process improvement initiatives. - Follow-up with payers to obtain timely approvals and resolve issues related to pediatric-specific criteria (e.g., age-based guidelines, developmental appropriateness). - Communicate denied authorizations and next steps to initiate the peer to peer or appeal process, track and manage the outcomes, and escalate any issues. - Refer families to Financial Counseling when patient responsibility amounts are identified and provide clear guidance to support caregiver understanding. - Maintain accurate records of authorization statuses and payer communications in the EHR. - Collaborate with care teams, including case management, to expedite authorizations for urgent services when needed. - Meet departmental standards for productivity, accuracy, and timeliness. Other information: Technical Expertise - Knowledge of medical terminology, CPT/ICD-10 codes, and pediatric insurance benefits. - Strong interpersonal communication skills to support families with empathy and clarity. - Ability to navigate multiple systems (EHR, payer portals); Epic experience preferred. - Understanding of medical necessity and documentation standards for pediatric services. Education and Experience - Education: High school diploma or equivalent required; associate degree or healthcare certification preferred. - Experience: Minimum 1 year in a Clinical, Revenue Cycle, Patient Access or Insurance company role that perform work related to; prior authorization, insurance verification, billing, scheduling, patient service rep, customer service, etc. required. - Pediatric healthcare access roles preferred. - Working with pediatric patients, families, or within a children's hospital preferred. - Familiarity with pediatric insurance policies, including Medicaid, managed care, and commercial plans preferred. Full Time FTE: 1.000000 Full-time, 40 Hours/Week Monday - Friday, Day Shift Remote (First 90 days onsite) Summary: The Authorization Specialist is responsible for obtaining prior authorizations and verifying insurance coverage for pediatric patients. This includes therapy, behavioral health, diagnostic procedures, specialist visits, surgeries, injections, infusion therapies, and advanced radiology services (CT, MRI, PET, and Nuclear Medicine). The specialist plays a critical role in ensuring timely access to care, supporting families in navigating the insurance process, and helping minimize financial barriers to treatment. Responsibilities: - Secure prior authorizations for a variety of pediatric services. - Verify insurance eligibility and benefits prior to service; ensure benefits and authorizations are clearly documented in the patient record. - Gather, verify, and review the necessary clinical documentation from providers, including medical records, progress notes, lab results, treatment plans, and any other require information to ensure requested services meeting payer medical necessity requirements based on CPT codes provided. - Coordinate with clinical and scheduling teams to prevent delays in care caused by pending or denied authorizations. - Participate in clinical huddles and team meetings to discuss challenges, share best practices, and contribute to process improvement initiatives. - Follow-up with payers to obtain timely approvals and resolve issues related to pediatric-specific criteria (e.g., age-based guidelines, developmental appropriateness). - Communicate denied authorizations and next steps to initiate the peer to peer or appeal process, track and manage the outcomes, and escalate any issues. - Refer families to Financial Counseling when patient responsibility amounts are identified and provide clear guidance to support caregiver understanding. - Maintain accurate records of authorization statuses and payer communications in the EHR. - Collaborate with care teams, including case management, to expedite authorizations for urgent services when needed. - Meet departmental standards for productivity, accuracy, and timeliness. Other information: Technical Expertise - Knowledge of medical terminology, CPT/ICD-10 codes, and pediatric insurance benefits. - Strong interpersonal communication skills to support families with empathy and clarity. - Ability to navigate multiple systems (EHR, payer portals); Epic experience preferred. - Understanding of medical necessity and documentation standards for pediatric services. Education and Experience - Education: High school diploma or equivalent required; associate degree or healthcare certification preferred. - Experience: Minimum 1 year in a Clinical, Revenue Cycle, Patient Access or Insurance company role that perform work related to; prior authorization, insurance verification, billing, scheduling, patient service rep, customer service, etc. required. - Pediatric healthcare access roles preferred. - Working with pediatric patients, families, or within a children’s hospital preferred. - Familiarity with pediatric insurance policies, including Medicaid, managed care, and commercial plans preferred. Full Time FTE: 1.000000

• Obtain and maintain prior authorization status for NELC patient medications/therapies • Work closely with the clinical review department to obtain documentation needed to complete the authorization process • Obtain needed documentation to support the billing department in meeting payer requirements for patient accounts

• Verify patient insurance eligibility, benefits, and coverage prior to treatment or service. • Secure prior authorizations from insurance companies for scheduled medical services and treatments. • Complete and submit authorization requests accurately and within required turnaround times. • Communicate with insurance providers via phone and payer portals to obtain authorization approvals and verify coverage details. • Coordinate with internal clinical and administrative teams regarding authorization status and any additional documentation requirements. • Maintain accurate and up-to-date records of insurance verifications, authorizations, approvals, denials, and follow-up activities. • Monitor pending authorization requests and proactively follow up to prevent delays in patient care. • Review payer requirements and ensure all submitted documentation meets insurance guidelines. • Escalate authorization issues or delays to the appropriate internal stakeholders when necessary. • Ensure compliance with patient confidentiality requirements and applicable healthcare regulations. • Perform other related duties as assigned.

Role Description Create and maintain operating procedures for the Consumer & Small Business Banking that comply with overarching operational policies that support Truist values and protect the relationship of the company within the marketplace and regulatory communities. Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time. - Create and maintain teammate operating procedures with a moderate to high technical complexity, focusing on efficiency, accuracy, and reducing ambiguity. Assess the need for end user communication when changes are needed or new procedures are created, assist with that communication, and coordinate publication dates. - Develop and maintain partnerships with Compliance, Legal, Risk, Subject Matter Experts, and End Users through open, timely, and accurate communications. Evaluate and respond to end user feedback by providing answers to teammate questions and scheduling procedure updates as needed. - Maintain an awareness of the intended and unintended consequences of actions. Assess gaps in processes and make recommendations to solve concerns. Use strategic thinking skills to influence change and gain buy-in from partners. - Perform an annual review of operating procedures, partnering with appropriate teammates, to determine if changes are needed to comply with regulatory/process changes. Document the review and coordinate end user communication. - Act as a mentor for other Procedure Specialists, provide training, and assist the Knowledge Delivery Manager with answering daily questions. - Manage competing priorities effectively and stay organized even with highly detailed work. Day-to-day activities include attending project meetings, updating procedures, educating partners on workflow, managing workflow, reviewing/publishing procedures, and escalating risk-based concerns. Qualifications - Bachelor's degree, or equivalent education and/or related training - 5 years' experience in a related field of banking operations or retail/commercial banking - Demonstrated strong interpersonal, leadership, communications, and analytical skills - Intermediate PC skills to include a good working knowledge of Microsoft Office - Demonstrated ability to prioritize, delegate, follow up, and expedite all issues daily - Solid knowledge of financial industry applicable laws such as Patriot Act, AML, and BSA, core deposit products and related activities, and banking systems Requirements - College Degree with a focus on business or technical writing or 3 years' experience in multiple areas of bank operations - At least two years of experience writing procedures for Truist - Experience with quality review, audits, and regulatory reporting - Experience with Truist lending processes and systems Benefits - Medical, dental, vision, life insurance, disability, accidental death and dismemberment - Tax-preferred savings accounts and a 401k plan - No less than 10 days of vacation (prorated based on date of hire and by full-time or part-time status) during the first year of employment - 10 sick days (also prorated) and paid holidays - Eligibility for Truist’s defined benefit pension plan, restricted stock units, and/or a deferred compensation plan