Insurance Authorization Specialist
At Lancaster General Health, our culture is what sets us apart and creates a lasting impression of our health system in the community and in the hearts of our patients and their families. A role with us is more than just a job, we ask that you Live Your Legacy at LGH by finding your passion in your everyday role, committing to those you serve, and reaching for your personal best.
We are recognized as 1 of only 9 hospitals in the entire country with awards in Medicare.Gov, LEAPFROG and Healthgrades Americas 50 Best Hospitals. We have attained five year Magnet ® recognition status for the fifth time with the American Nurses’ Credentialing Center (ANCC) and we are the 2018 recipient of the Foster G. McGaw Prize in recognition of the commitment to community service.
PENN MEDICINE LANCASTER GENERAL HEALTH offers a comprehensive benefits package:
We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program so that our employees can stay actively engaged and committed to living their legacy every day. Together, we will continue to make medical advances that help people live longer, healthier lives.
Join us and be part of a team that empowers you to do more than your job and encourages you to:
Live Your Passion. Live Your Best. Live Your Commitment. Live Your Legacy.
POSITION SUMMARY: To ensure payment from insurance companies for services provided as well as an extraordinary experience for the patient, this role provides complete and accurate patient insurance verification for hospital and outpatient hospital services. The role also handles non-clinical referrals.
ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:
- Coordinate pre-authorization process
- Confirm the authorization is on file in a timely manner.
- Liaise with doctor’s offices, insurance representatives, Financial Services personnel (PFS), and other departments across the organization to ensure authorization and/or referrals for services on file and accurate with the payer resulting in maximized reimbursement.
- Consistently identifies and resolves deficiencies with customer registration issues including but not limited to: insurance inquiries, CPT code changes and patient status changes.
- Manages and resolves coverage and authorization issues from intake to final resolution.
- Analyzes and researches all escalated authorization/referral issues in a professional manner.
- Maintains a thorough understanding of the revenue cycle including: insurance requirements, billing standards, and associated correspondence to be able to independently resolve issues.
- Maintains professional relationships with a wide variety of community providers.
- Consistently documents appropriate information in department-designated sections of EMR regarding insurance and authorization.
- Analyzes and researches denials to resolve denied claims with the appropriate payer and/or provider office.
- Provides missing or additional information to expedite the resolution of the denied claim.
- Evaluates denied claims to determine when appeals are warranted and collaborates with the appropriate payer and/or practice to resolve issue.
- Evaluates processes/procedures to continuously improve job functions striving for the best outcomes for the five pillars of LEAN.
SECONDARY FUNCTIONS: The following duties are considered secondary to the primary duties listed above:
- Helps foster an environment of continuous improvement by suggesting ideas to leadership.
- Participates in shadowing experiences with payer representatives, other departments and provider.
- Other duties as assigned.
MINIMUM REQUIRED QUALIFICATIONS:
- High school diploma or equivalent (GED)
- Strong written and verbal communication and organization skills.
- Excellent computer skills including Microsoft Office products.
- Ability to apply strong analytical qualities
- Demonstrates ability to be self-motivated and prioritize tasks efficiently and accurately.
- Demonstrates the ability to work as a team member.
- Associate’s degree.
- Prior experience with authorizations.
- One (1) year of experience in a healthcare related administrative or billing setting.
Attention/Concentration: The following level of ability is essential for the jobholder to focus on certain aspects of current experience and reject others.
- The position requires the ability to attend to more than one aspect of a situation simultaneously. It is highly likely that multiple task demands are going to be required of the individual at the same time.
New Learning and Memory: The following level of ability is essential for the jobholder to learn and retain material.
- A large portion of this position required reliance on verbal memory and new learning. Efficiency in processing of verbal information, either in written or spoken form, is a major requirement and prerequisite of the job. The individual must be able to attend to and process multiple bits of information simultaneously. The individual must be able to organize and categorize this information effectively so that later recall is feasible.
Problem Solving, Reasoning and Creative Thinking: The following level of ability that is essential for the jobholder to think (in order to solve a problem) by combining two or more elements from past experience or imaginative thought.
- The position deals with issues or problems that often require thoughtful reasoning before arriving at approaches or solutions. Some independent thought, planning or origination of options and solutions is necessary. The individual must have the ability to apply principles of reasoning and problem solving to resolve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
APTITUDES: The following are essential requirements of the position in relation to job-worker situations. These items describe how a worker must adapt, adjust, conform or act.
Repetitive work: Ability to continuously perform the same type of work for extended periods of time, according to set procedures, sequence or pace.
EQUIPMENT USAGE REQUIREMENTS
Equipment/Tools: Computer, Phone, Copier, Printer, Fax, Office Supplies.
Software: Clinical information system, e-mail, Microsoft Office Products.
Rarely 0-10%; Occasionally 11-35%; Frequently 36-70%; Continuously 71-100%
- Sit: Continuously
- Stand: Rarely
- Walk: Rarely
- Bend: Rarely
- Push: Rarely
- Pull: Rarely
- Kneel/Squat: Rarely
- Reach: Rarely
- Twist: Rarely
- Balance: Rarely
- Climb: Rarely
Lifting: Degree of physical exertion is:
Light, exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to move objects.
Sensory Abilities specifically required:
Exposure to hazardous conditions/ materials is negligible.
Disclaimer: This job description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended to be a reflection of those principal job elements essential for recruitment and selection, for making fair job evaluations, and for establishing performance standards. The percentages of time spent performing job duties are estimates, and should not be considered absolute. The incumbent shall perform all other functions and/or be cross-trained as shall be determined at the sole discretion of management, who has the right to amend, modify, or terminate this job in part or in whole. Incumbent must be able to perform all job functions safely.
Benefits of Joining Penn Medicine Lancaster General Health:
PENN MEDICINE LANCASTER GENERAL HEALTH combines a Nationally Ranked Hospital with great schools, safe neighborhoods, affordable housing, local community events and festivals as well as a wealth of cultural and recreational activities. The scenic Susquehanna River Valley provides opportunities for fishing, skiing, kayaking, hiking and mountain biking in addition to easy access to NJ shoreline or Delaware beaches. Urban life is easily accessible, with New York, Baltimore, Philadelphia and Washington D.C. a train ride away. Local universities, Fulton Theatre, the downtown shopping and dining district and local sports teams make Lancaster a great place to Live, Work and Play.
PENN MEDICINE LANCASTER GENERAL HEALTH is an Equal Opportunity Employer, committed to hiring a diverse workforce. All openings will be filled based on qualifications without regard to race, color, sex, sexual orientation, gender identity, national origin, marital status, veteran status, disability, age, religion or any other classification protected by law.
Search Firm Representatives please read carefully: PENN MEDICINE LANCASTER GENERAL HEALTH is not seeking assistance or accepting unsolicited resumes from search firms for this employment opportunity. Regardless of past practice, all resumes submitted by search firms to any employee at PENN MEDICINE LANCASTER GENERAL HEALTH via-email, the Internet or directly to hiring managers at Penn Medicine Lancaster General Health in any form without a valid written search agreement in place for that position will be deemed the sole property of PENN MEDICINE LANCASTER GENERAL HEALTH, and no fee will be paid in the event the candidate is hired by PENN MEDICINE LANCASTER GENERAL HEALTH as a result of the referral or through other means.
Posted on 12/08/2021