The Insurance Authorization Specialist supports the Patient Access Department by accurately verifying insurance information, reviewing patient accounts for prior authorization needs, obtaining needed prior authorizations, and properly documenting all steps in the process. This position will also serve as a point of contact for clients and coworkers to ensure we process our insurance verification and authorization efforts to best care for our patients. This position may assist with training and mentoring other staff members as well as being available in the same capacity for our clients as needed. This position plays a key role in providing a smooth experience for patients and ensuring the organization receives appropriate reimbursement.

Principal Duties and Responsibilities

• Utilizes online systems, phone communication, and other resources to determine insurance eligibility and prior authorization needs for a scheduled patient event.
• Verifies benefits, extent of coverage, pre-certification and pre-authorization requirements. Plus other limitations within a timeframe before scheduled appointments determined by Jennie Stuart Health.
• Follows prior authorization work flow, policies and procedures
• Collaborate with other departments to assist in obtaining pre-authorizations in a cross functional manner
• Manage correspondence with insurance companies, physicians, specialists and patients as required
• Create patients’ records and accounts and ensure that pre-authorization information is properly updated in them
• effectively communicating with patients, physicians, clinicians, front-end staff, and translators
• Coordinates benefits by effectively determining primary and secondary liability when needed
• Obtains pre-certifications and pre-authorizations from third-party payers in accordance with payer requirements
• Alerts physician offices and patients to issues with verifying insurance or meeting pre-authorization requirements
• Assists in training new insurance verification staff in accordance with organization’s standards
• Complies with all state and federal laws and regulations related to patient privacy and confidentiality, such as HIPAA
• Performs other clerical duties as assigned by Patient Access Director and/or manager
• Exhibits professionalism in appearance, speech, and conduct; ensures that services are provided in accordance with organizational standards and policies
• Experience as an Insurance Verification and Referrals within the organization, or at least two to three years of insurance verification or healthcare administration experience outside the organization required
• Customer service experience preferred
• Proficient knowledge of the following:

• * EHR programs (e.g., Sunrise, AllScripts and Athena, etc;)
  

  • Medical terminology
  • ICD-10, CPT, HCPCS codes, and coding processes
  • Various payer regulations and contracts
• Ability to motivate and mentor others
• Knowledge of other front-end processes, including scheduling, pre-registration, financial counseling, medical necessity, and registration.
• Superb teamwork and conflict resolution skills
• Efficient time management skills and ability to multitask
• Excellent writing, oral, and interpersonal communication skills
• Strong understanding and comfort level with computer systems

Required Skills

• Experience with insurance verification and referrals within the organization, or at least two to three years of insurance verification or healthcare administration experience outside the organization required
• Customer service experience preferred
• Proficient knowledge of the following EHR programs (e.g., Sunrise, AllScripts, Athena, etc; )
• Medical terminology
• ICD-10, CPT, HCPCS codes, and coding processes
• Various payer regulations and contracts
• Ability to motivate and mentor others
• Knowledge of other front-end processes, including scheduling, pre-registration, financial counseling, insurance authorization, medical necessity, and registration.
• Superb teamwork and conflict resolution skills
• Efficient time management skills and ability to multitask
• Excellent writing, oral, and interpersonal communication skills
• Strong understanding and comfort level with computer systems

Required Experience

Education:

• High school diploma or GED required
• Associate or bachelor’s degree in healthcare administration or related field preferred
• Certified Healthcare Access Associate (CHAA) certification preferred

• Experience with insurance verification and referrals within the organization, or at least two to three years of insurance verification or healthcare administration experience outside the organization required
• Customer service experience preferred
• Proficient knowledge of the following EHR programs (e.g., Sunrise, AllScripts, Athena, etc; )
• Medical terminology
• ICD-10, CPT, HCPCS codes, and coding processes
• Various payer regulations and contracts
• Ability to motivate and mentor others
• Knowledge of other front-end processes, including scheduling, pre-registration, financial counseling, insurance authorization, medical necessity, and registration.
• Superb teamwork and conflict resolution skills
• Efficient time management skills and ability to multitask
• Excellent writing, oral, and interpersonal communication skills
• Strong understanding and comfort level with computer systems