Insurance Authorization Specialist (Fulltime/Days)

Schedule

Fulltime/40 Hours Per Week/Days/7:30am – 4pm

Location

Commercial Avenue, Lancaster Pa.

Position Summary

To ensure payment from insurance companies for services provided as well as an extraordinary experience for the patient, this role provides complete and accurate patient insurance verification for hospital and outpatient hospital services. The role also handles non-clinical referrals.

Essential Functions

• Cook up the pre-authorization process
• Confirm the authorization is on file in a timely manner
• Liaise with doctor’s offices, insurance representatives, Financial Services personnel (PFS), and other departments across the organization to ensure authorization and/or referrals for services on file and accurate with the payer resulting in maximized reimbursement
• Consistently identifies and resolves deficiencies with customer registration issues including but not limited to: insurance inquiries, CPT code changes and patient status changes
• Manages and resolves coverage and authorization issues from intake to final resolution
• Analyzes and researches all escalated authorization/referral issues in a professional manner
• Maintains a thorough understanding of the revenue cycle including: insurance requirements, billing standards, and associated correspondence to be able to independently resolve issues
• Maintains professional relationships with a wide variety of community providers
• Maintains appropriate information in department-designated sections of EMR regarding insurance and authorization
• Analyzes and researches denials to resolve denied claims with the appropriate payer and/or provider office
• Provides missing or additional information to expedite the resolution of the denied claim
• Evaluates denied claims to determine when appeals are warranted and collaborates with the appropriate payer and/or practice to resolve issue
• Evaluates processes/procedures to continuously improve job functions striving for the best outcomes for the five pillars of LEAN
• Helps foster an environment of continuous improvement by suggesting ideas to leadership
• Participates in shadowing experiences with payer representatives, other departments and provider

Minimum Required Qualifications

• Req H.S. Diploma/GED
• Pref Associate's Degree
• Pref Prior experience with authorizations
• Pref 1+ years experience in a healthcare related administrative or billing setting