Job Description:

• Authorizes and pre-certifies services by coordinating and performing activities required for verification and authorization of insurance benefits
• Proactively identifies resources available for families if health plan does not include coverage for services
• Coordinates counseling services with Financial Counseling and ensures the standards of Surprise Billing is communicated
• Collaborates with Patient Financial Services (PFS) and Managed Care department regarding denied claims
• May initiate and perform revenue cycle activities required for pre-registration
• Works collaboratively with team members to provide quality service that ensures delivery of safe patient care and services
• Conducts in depth account review including but not limited to, denial management, clinical follow up, and acts as a liaison between clinical stakeholders and payor representation
• Interviews patients and/or family members to secure insurance coverage, eligibility, and qualification for various financial programs
• Coordinates and performs verification of insurance benefits by contacting insurance provider and determining eligibility of coverage
• Confirms referring physician and/or servicing physician has obtained notification/confirmation of prior authorization as needed from insurance company for all scheduled healthcare procedures within assigned department/area
• Contacts referring physicians and or/patients to discuss rescheduling of procedures due to incomplete/partial authorizations
• Acts as liaison between clinical staff, patients, referring physician’s office, and insurance by informing patients and families of any possible changes, updates, responses or follow up
• Monitors patients on schedule, ensuring that eligibility and authorization information has been entered into data entry systems
• Pre-screens doctor’s orders (scripts) received for new patients to ensure completeness/appropriateness of scheduled appointment
• Collaborates with Patient Financial Services (PFS) department to provide all related information regarding denied claims
• Monitors insurance authorization issues to identify trends and participates in process improvement initiatives
• Responds to all inquiries related to authorization/pre-certification issues
• Develops and maintains knowledge in medical terminology, billing and insurance guidelines to ensure compliance with all regulatory expectations

Requirements:

• At least one year of insurance verification experience
• Bachelor's degree (preferred)
• Experience in a pediatric hospital (preferred)
• High school diploma or equivalent
• Working knowledge of basic medical terminology
• Ability to multitask and problem-solve
• Ability to work independently in a changing environment and handle stressful situations
• Must be able to speak and write in a clear and concise manner to convey messages
• Proficient in Microsoft Word/Excel/Outlook

Benefits:

• comprehensive compensation and benefit package
• array of programs and services