Role Description Contacts insurance companies and other third party payers to determine pre-certification, pre-authorization and/or medical necessity requirements for complex outpatient hospital services, and specialized procedures (i.e. Recurring Visits, Surgeries, IR). - Obtains pre-certification or pre-authorization prior to the scheduled complex service being performed. - Liaisons with physicians and physician office staff when needed to obtain additional demographic, insurance or clinical information. - Notify payers of admittance if required. Qualifications - H.S. Diploma or General Education Degree (GED) - Required - Bachelor’s Degree from a recognized college or university - Preferred - Completion of medical coder training program - Preferred Requirements - 3 years exp in Rev Cycle or related exp in healthcare, with one of those years working specifically within Healthcare Revenue Cycle - Required - 4 years of previous related healthcare Revenue Cycle experience - Preferred - Prior Epic experience - Preferred - Clinical experience (i.e., medical assistant, surgical tech) - Preferred Company Description Business Unit: Company Name - Piedmont Healthcare Corporate

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.