Health Insurance & Authorization Specialist II

About the role

The Health Insurance and Authorization Specialist verifies patient insurance eligibility and coverage, secures third-party payer authorization, and notifies Utilization Management of clinical requests. They also assist uninsured/underinsured patients with referrals to Financial Case Management and track Medicare patients for LTR consent forms.

Responsibilities

• Verify patient insurance eligibility and coverage
• Secure third-party payer authorization for urgent/emergent inpatients, observation cases, maternity, and newborn admissions
• Notify Utilization Management of clinical requests during the hospital stay
• Work closely with uninsured/underinsured patients for appropriate referrals to Financial Case Management
• Track Medicare patients for benefit exhaustion to ensure compliance with LTR consent forms
• Exercise judgment to resolve insurance barriers on assigned admissions to avoid billing delays
• Coordinate with MVA/WC carriers, MVAIC agency, attorney offices, and parents to add newborns through the NYS Marketplace or employer group

Requirements

• High school Diploma or equivalent required
• Associate degree preferred in related discipline (admitting/registration/patient billing/insurance)
• Minimum of 3 years of related experience preferably in a hospital setting, medical office billing, or knowledge of third-party insurance regulations

Skills

• High degree of professionalism and motivation
• Excellent communication and customer service skills
• Medical terminology knowledge
• Good interpersonal and telephone skills
• Detail oriented
• Computer, copier, and FAX skills