Hospital Authorization Specialist

Nemours • Wilmington, DE

403d

About The Position

The position involves managing authorization requests for patient services at Nemours Children's Health, ensuring compliance with departmental policies and payer requirements. The role requires effective communication with families and collaboration with various departments to facilitate insurance processes and provide excellent customer service.

Requirements

• Authorization experience required.
• High School Diploma required.
• Specialized training (1 year beyond high school) is required.
• Minimum 6 months of experience required.

Responsibilities

• Ensure timely handling of authorization requests according to departmental policy and payer requirements.
• Verify patient demographics, insurance eligibility, benefits, and financial responsibility accurately.
• Request and obtain preauthorization for assigned specialties and cover for other specialties as needed.
• Build and maintain professional relationships with departments impacting authorization processes.
• Contact families to obtain necessary information and assist with insurance issues, including Medicaid enrollment.
• Prepare estimates for scheduled services and interpret patient benefits for accurate estimates.
• Document all communications with payers, physicians, and families in standardized formats.
• Communicate effectively and professionally in writing and verbally.
• Demonstrate excellent customer service skills to internal and external customers.
• Collaborate with Financial Services for newborn enrollment and self-pay referrals.
• Follow newly implemented workflows and participate in Continuous Improvement projects as required.

Benefits

• Medical/Dental/Vision Insurance
• Tuition Reimbursement/Continuing Education Support
• 403(b) Retirement Plan
• Paid Time Off (PTO)
• Volunteer Time Off (VTO)
• 6 paid holidays
• Professional/Clinical growth opportunities
• Work Life Benefits

What This Job Offers

• Job Type: Full-time
• Industry: Hospitals
• Education Level: High school or GED