Insurance Specialist I

Prior Authorizations Summary

Responsible for the pre-verification of insurance for patients being admitted into the hospital for care. Ensures insurance coverage, resolves any issues with coverage and escalates complicated issues. Verifies, interprets, coordinates, disseminates insurance information; establishes and counsels patient on co-payments, maintains charge capture information.

Required Education

No education requirements

Required Work Experience

Entry Level - Experience Not Required

Description

• Obtains pre-authorization approvals for outpatient procedures from the Surgery, Day Medicine, Radiology, Nuclear Medicine, Genetics, Sleep lab and Heart Station departments.
• Preregisters, obtains prior authorization, price estimates, PCP referrals, upfront collections and referred accounts prior to date of service.
• Obtains prior authorizations and insurance verification for all clinics, Medicare patients, out-of-state Medicaid, SDC and for specialty drugs.
• Obtains the appropriate prior authorizations for surgical and outpatient procedures and the necessary CPT/ICD-10 diagnosis codes when appropriate.
• Obtains price estimates, upfront collections and referred accounts prior to date of service.
• Completes outbound calls to families regarding insurance coverage and benefits, high deductibles, co-pays, denials.
• Conducts appropriate follow-ups and verifications on all assigned accounts including documenting in the patients account detailed insurance information prior to services being rendered.
• Serves as a liaison between the clinical staff and insurance payers.
• Collects deductible, co-pay and all other applicable payments.
• Performs other duties as assigned.

Salary

Most new hires start between $16.30-$20.30 per hour, depending on experience and qualifications.

Additional Information

Current employees: Please apply via the internal career site by logging into your Workday Account (https://www.myworkday.com/archildrens/) and search the "Find Jobs" report.