Finance and Authorization Specialist

Rochester Regional Health

36d•$18 - $25•Onsite

About The Position

The primary responsibility of the Finance and Authorization Specialist is to promptly verify patient’s insurance, obtain and verify if not provided, provide accurate patient estimate as requested, obtain or verify authorization for the procedures and treatments ordered by the department and ordering providers, and maintain communication to multiple departments with findings and issues.

Requirements

Previous experience with insurance verification and benefit application, familiarity with ICD-10 diagnosis, and procedure codes, and CPT/HCPCS codes.
Proficiency in a variety of computer applications, spreadsheet applications, and common office equipment.
Flexibility and ability to work as a team player
Ability to handle simultaneous tasks paying great attention to detail
Excellent communication skills including both oral and written as well as interpersonal skills.
Excellent problem solving and follow through skills.
Experience using EMR software
Additional basic computer skills required
Excellent customer service and communication skills required.
2 years related work experience in a healthcare or insurance setting

Responsibilities

Utilize appropriate insurance verification tools to validate patient insurance eligibility
Generate timely patient estimates through the use of Rochester Regional Health's Estimate Tool
Support internal offices with generating estimates for future services, as requested
Deliver Price Estimates to patients in a courteous and knowledgeable manner
Deliver finalized estimate findings to patient via phone call, email, or MyCare channels
Obtain prior-authorization on both internal and external department orders for procedures/treatments performed in the department; applicable to both new and established patients.
Coordinate with Patient Registration to appropriately and accurately schedule patients in accordance with the provider's orders.
Communicate with other departments to address scheduling or authorization issues
Complete forms and letters to insurance for visit coverage
Monitor daily schedules for add-on appointments, insurance changes, and work accordingly within our policies to verify insurance, process estimates, and/or obtain authorizations.
Monitor pending authorizations and follow due process should it need to be rescheduled
Participate in orientation of new staff
Obtain referrals from payers that require it
Obtain insurance information through various searches when not in the system
Complete other duties as assigned
Obtain prior-authorization on internal department orders for medications administered at oncology infusion locations; applicable to both new and established patients.
Review Oncology infusion orders for medical necessity per CMS, Manufacturer, or NCCN guidelines. Work with physicians if these specific guidelines are not met by documentation.
Verify authorizations for non-oncology patients for whom we have received medication administration orders.
Communication to Oncology pharmacy of insurer preferred brands for requested products.
Assist with research and resolution of denials as requested.