Insurance Authorization Specialist (Full Time/ Day Shift)
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.
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.
PENN MEDICINE LANCASTER GENERAL HEALTH offers the following benefits to employees:
- 100% Tuition Assistance at The Pennsylvania College of Health Sciences
- Paid Time Off and Paid Holidays
- Shift, Weekend and On-Call Differentials
- Health, Dental and Vision Coverage
- Short-Term and Long-Term Disability
- Retirement Savings Account with Company Matching
- Child Care Subsidies
- Onsite Gym and Fitness Classes
Posted on 01/10/2023
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.