Insurance Verification and Authorization Specialist

Bryan Health • Lincoln, NE

297d

About The Position

Responsible for verifying patient insurance and benefits and obtaining prior authorization for scheduled medical services and hospital admissions following payer-specific guidelines. Responsible for ensuring urgent/emergent cases are worked within one business day of admission and all elective cases worked prior to date of service.

Requirements

• High school diploma or equivalency required.
• Associates degree preferred.
• Certified Medical Assistant or Licensed Practical Nurse preferred.
• Minimum of one (1) year of relevant work experience (i.e. hospital billing, coding or prior pre-authorization experience) preferred.
• Must be 19 years of age to witness legal consents.

Responsibilities

• Commits to the mission, vision, beliefs and consistently demonstrates our core values.
• Serves as work resource and liaison to hospital departments, physician offices, and patients for pre-service authorizations or financial responsibility questions.
• Adheres to federal regulations regarding Advance Directives, COBRA, Medicare, Corporate Compliance, Joint Commission, OSHA and HIPAA; reports safety and customer concerns.
• Maintains productivity and quality standards as defined through the organizational and departmental goals and objectives.
• Verifies third party insurance coverage from daily admissions and scheduling databases; including contacting ordering physician's office for missing insurance and procedure information and updates appropriate software systems.
• Facilitates authorization process with offices and providers.
• Ensures that pre-certification and/or authorization and referral requirements have been completed by placing phone calls to insurance companies, physician offices, patients, and utilizing web based applications and/or internet resources; obtains clinical information from physician offices and/or Bryan system; contacts Health Information Management to obtain CPT and/or ICD-9 codes.
• Submits patients supporting medical records and necessary information to payer authorization representatives for prior authorizations via fax, phone or online portals.
• Notifies Care Management when eligibility and/or benefits are complete on applicable admissions; notifies CM about Medicare Dental Carries patients.
• Accurately and completely documents all actions taken regarding the prior authorization process including the authorization numbers, authorized dates and other applicable information in the applicable computer systems.
• Maintains accurate payer website information and logins to ensure the most current information is obtained for the necessary authorization requirements.
• Provides effective communication, proactively and in response, to patients/family members, team members, physicians and other healthcare providers while maintaining confidentiality.
• Supports the financial goals of Bryan Medical Center by communicating with patients and their insurance companies to obtain pertinent information about procedure reimbursements and patient responsibilities.
• Explains notice of non-coverage or offers to re-schedule elective tests and procedures, when patient's pre-authorization is not obtained; notifies patient and physician of outcome.
• Prepare and provide patients with an estimate, if one is warranted, for their expected services and/or connect the patient/guarantor to the estimates team.
• Communicates with Patient Financial Services regarding denials and appeals/reconsideration letters received from payers.
• Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.
• Participates in meetings, committees and department projects as assigned.
• Performs other related projects and duties as assigned.

What This Job Offers

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