Preauthorization Specialist

Job Summary:

Under the direction of the Financial Coordinator Supervisor, ensures that all information necessary for proper financial reimbursement for high dollar patient care is analyzed and submitted to insurance companies for approval prior to the patient's date of service. Collaborates with insurance companies and physician offices when necessary to verify eligibility and authorization requirements to ensure financial reimbursement for services.

Essential Functions:

• Perform all insurance verification for eligibility, coverage, and authorization requirements via Web or phone with third party payers.

• Ensures all possible coverages are created and verified, through electronic or manual methods, and all discrepancies are resolved. Validates that coverages are assigned to appropriate visit. -Collects and validates order-related information including office visit, radiology and surgical orders. Follows up with ordering provider to verify CPT codes.

• Escalates challenging accounts to team lead to ensure accounts are approved at prior to patient appointment/surgery. Escalates non-certified urgent cases to appropriate clinical departments and leadership for approval to proceed or communicate rescheduling.

• Contacts providers and insurance companies to validate data, collect missing information and resolve information discrepancies, -Understands clinical guidelines for payors requiring authorization to better build cases for authorization requests and provide feedback to clinical departments on required notes.

• Work closely with physician offices obtaining authorization for inpatient and outpatient services

Work collaboratively with Case Management for all patients' financial issues and updating accounts

Qualifications:

Education

• High school graduate or equivalent; some college preferred

Experience

• 1-2 years of insurance, third party payor or secretarial experience in a health care setting required

Knowledge and Skills

• Medical Terminology required

• Analytical ability to gather and interpret data and communicate desired outcomes orally and in writing in a professional manner

• Strong communication and interpersonal skills

• Ability to handle multiple duties