Ins Verify Rep III - Prior Authorization

Cincinnati Children's•Mount Vernon, VA

5d•$22 - $28

About The Position

JOB RESPONSIBILITIES Pre-Authorization - Utilize systems including medical records to obtain needed clinical support to efficiently confirm receipt of or to obtain pre-authorization for scheduled services and medications that require a higher level of clinical knowledge. Collaborate with internal and external resources regarding specific authorizations scenarios and manages escalated issues and provides feedback to team members. Work with team to make contact with families prior to patient scheduled visits and/or services to confirm insurance eligibility, referrals/authorizations with minimal stress to the family/patient. Problem Resolution - Serve as second level problem resolution for both internal and external customers, involving Manager, if necessary. Responsible for research, analysis and resolution of complex issues and questions. Identify patterns in questions and problem issues with staff and participate in determining and addressing root causes. Collaboration - Serve as a liaison between Hospital/Physicians Billing Service, Admitting, Outpatient Surgery, Outpatient Department, Patient Financial Services, Utilization Review and other Cincinnati Children's departments. Multiple division support; cross trained in order to work insurance pre-authorization for multiple divisions. Participate in Department Meetings to share payer trends related to Pre-Authorizations. Productivity - Work independently and/or collaboratively with team to efficiently handle work volume and queues to meet or exceed productivity standards. Accurately collect/verify insurance information and demographics, obtaining insurance authorization and entering the information into the required systems. Assign tasks to the appropriate skill level as needed to ensure efficiency and productivity. Coordination - Serve as an internal and external resource/expert for health insurance questions from customers/clients. Act as a preceptor for new employees and provide instruction for performing non-routine functions for staff. Work collaboratively with team to establish and maintain payer specific coverage libraries and communicate/update payer information health system requirements utilizing departmental SharePoint or other resources. Working knowledge and functions of multiple divisions. Complete retrospective authorizations when necessary.

Requirements

High school diploma or equivalent
3+ years of work experience in a related job discipline

Responsibilities

Pre-Authorization - Utilize systems including medical records to obtain needed clinical support to efficiently confirm receipt of or to obtain pre-authorization for scheduled services and medications that require a higher level of clinical knowledge.
Collaborate with internal and external resources regarding specific authorizations scenarios and manages escalated issues and provides feedback to team members.
Work with team to make contact with families prior to patient scheduled visits and/or services to confirm insurance eligibility, referrals/authorizations with minimal stress to the family/patient.
Problem Resolution - Serve as second level problem resolution for both internal and external customers, involving Manager, if necessary.
Responsible for research, analysis and resolution of complex issues and questions.
Identify patterns in questions and problem issues with staff and participate in determining and addressing root causes.
Collaboration - Serve as a liaison between Hospital/Physicians Billing Service, Admitting, Outpatient Surgery, Outpatient Department, Patient Financial Services, Utilization Review and other Cincinnati Children's departments.
Multiple division support; cross trained in order to work insurance pre-authorization for multiple divisions.
Participate in Department Meetings to share payer trends related to Pre-Authorizations.
Productivity - Work independently and/or collaboratively with team to efficiently handle work volume and queues to meet or exceed productivity standards.
Accurately collect/verify insurance information and demographics, obtaining insurance authorization and entering the information into the required systems.
Assign tasks to the appropriate skill level as needed to ensure efficiency and productivity.
Coordination - Serve as an internal and external resource/expert for health insurance questions from customers/clients.
Act as a preceptor for new employees and provide instruction for performing non-routine functions for staff.
Work collaboratively with team to establish and maintain payer specific coverage libraries and communicate/update payer information health system requirements utilizing departmental SharePoint or other resources.
Working knowledge and functions of multiple divisions.
Complete retrospective authorizations when necessary.