AUTHORIZATION SPECIALIST

About the role

Financially clears scheduled inpatient and outpatient services, including office visits, testing, diagnostic studies, surgeries and procedures, prior to date of service. Financial clearance process encompasses any or all of the following job functions:

• Verifies insurance eligibility and plan benefits.
• Contact patients with inactive insurance coverage to obtain updated insurance information.
• Validates coordination of benefits between insurance carriers.
• Explains insurance plan coverage and benefits to patients, as necessary.
• Sets up insurance authorizations and pre-certifications for patient services both internally and externally to Cooper.
• Contacts external primary care physicians to obtain referrals for patients scheduled with Cooper providers.
• Refers patients with less than 100% coverage to Financial Screening Navigators.
• Identifies copayment, deductible and co-insurance information.
• Collects and processes patient liability payments prior to service.

Responsibilities

Experience Required:

• 2 years of insurance verification or registration experience in a hospital or physician office preferred.
• Working knowledge of medical insurance plans & products, coordination of benefits guidelines, and requirements for authorizations, pre-certifications and referrals preferred.
• Proficiency in working with payor on-line portals, as well as NaviNet, Passport or other third-party eligibility systems preferred.
• Experience working in a high-volume call center preferred.
• Proficiency in IDX Flowcast, Imagecast, and EPIC EMR systems preferred.

Requirements

Education Requirements:

• A High School Diploma or equivalent.

Special Requirements

• Skilled in use of computers and software applications, i.e., Microsoft Word, Excel, Outlook, Access, registration and billing systems.
• Basic knowledge of medical diagnoses and procedural codes.
• Excellent verbal and written communications skills.
• Ability to organize, take independent action and project Cooper values to customers and coworkers.