BH Insurance/Precert Specialist

Nationwide Children's Hospital•Columbus, OH

43d•Hybrid

About The Position

Verifies and documents benefit information. Requests initial authorization and meets provider’s referral requirements to ensure that optimum payment is made to the hospital and providers. Contacts insurance companies to obtain and verify benefit information, documents all benefit information, and meets payer’s referral requirements to ensure that optimum payment to the hospital and providers will be satisfied. Obtains insurance prior authorization as needed and documents the verification of benefits and prior authorizations in Epic. Maintains record of pending prior authorizations and documents timely follow-up. Assists with the retrospective review of records for patients who have insurance changes that impact the authorization. Communicates authorization denials and appeal options to referral sources/Providers. Assists with coverage resources as appropriate. Contacts schedulers if insurance cannot be verified and refers self-pay patients to financial assistance resources. Participates in department and interdepartmental meetings to promote knowledge, troubleshoot, and resolve issues related to benefits or authorizations. Maintains knowledge of The Joint Commission, Medicaid, Medicare, and other third-party payer standards and requirements.

Requirements

High school graduate, required.
Strong computer skills required with the ability to navigate most current technology systems.
Excellent written, communication, and organizational skills required.
CPR certification (based on position and as determined by manager).

Nice To Haves

Associate’s Degree, preferred.
One year previous health care or insurance experience preferred.

Responsibilities

Contacts insurance companies to obtain and verify benefit information.
Documents all benefit information.
Meets payer’s referral requirements to ensure that optimum payment to the hospital and providers will be satisfied.
Obtains insurance prior authorization as needed.
Documents the verification of benefits and prior authorizations in Epic.
Maintains record of pending prior authorizations and documents timely follow-up.
Assists with the retrospective review of records for patients who have insurance changes that impact the authorization.
Communicates authorization denials and appeal options to referral sources/Providers.
Assists with coverage resources as appropriate.
Contacts schedulers if insurance cannot be verified and refers self-pay patients to financial assistance resources.
Participates in department and interdepartmental meetings to promote knowledge, troubleshoot, and resolve issues related to benefits or authorizations.
Maintains knowledge of The Joint Commission, Medicaid, Medicare, and other third-party payer standards and requirements.