Insurance Authorization Specialist II

MINIMUM QUALIFICATIONS:

PREFERRED QUALIFICATIONS:

EXPERIENCE:
1. Previous insurance authorization experience.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1. Identifies all patients requiring pre-certification or pre-authorization at the time services are requested or when notified by another hospital or clinic department.
2. Follows up on accounts as indicated by system flags.
3. Contacts insurance company or employer to determine eligibility and benefits for requested services.
4. Follows up with the patient, insurance company or provider if there are insurance coverage issues in order to obtain financial resolution.
5. Use work queues within the EPIC system for scheduling, transition of care, and billing edits.
6. Performs medical necessity screening as required by third party payors.
7. Documents referrals/authorization/certification numbers in the EPIC system.
8. Initiates charge anticipation calculations.  Accurately identifies anticipated charges to assure identification of anticipated self-pay portions.
9. Communicates with the patient the anticipated self-pay portion co-payments/deductibles/co-insurance, and account balance refers self-pay, patients with limited or exhausted benefits to the in-house Financial Counselors to determine eligibility.
10. Assists Patient Financial Services with denial management issues and will appeal denials based on medical necessity as needed.
11. Communicates problems hindering workflow to management in a timely manner.
12. Assesses all self-pay patients for potential public assistance through registration/billing systems Provides self-pay/under-insured patients with financial counseling information. Maintains current knowledge of major payor payment provisions.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Prolonged periods of sitting.
2. Extended periods on the telephone requiring clarity of hearing and speaking.
3. Manual dexterity required to operate standard office equipment.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment. 

SKILLS AND ABILITIES:

1. Excellent oral and written communication skills.
2. Basic knowledge of medical terminology.
3. Basic knowledge of ICD-10 and CPT coding, third party payors, and business math.
4. General knowledge of time of service collection procedures.
5. Excellent customer service and telephone etiquette.
6. Minimum typing speed of 25 works per minute.
7. Must have reading and comprehension ability.