Insurance Authorization Specialist - Horizon Healthcare Services
3310 Horizon Health Services Operations
Patient Account Services
This position is located in Lancaster, PA. Full-time, 40 hrs/week, 8:30am-5pm Monday-Friday. Every 8th weekend working Saturday with prior Monday off.
ATTENTION: Please be aware that, if you are an external applicant, you may need to complete an online assessment as part of the hiring process. This assessment will be sent to the e-mail address that you included in your application. Please note: Some e-mail accounts may receive the assessment e-mail in their junk/spam e-mail. This assessment must be completed within 5 days of receiving it. For more information regarding the assessment, please click HERE.
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 home infusion services.
ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:
- Serves as the primary point of contact between the patient and owner hospitals to ensure authorization and or referrals for services are on file with the payer.
- Identifies and resolves customer registration issues including but not limited to, charge inquiries, insurance inquiries, ICD10 coding and patient status changes.
- Identifies and resolves coverage and authorization issues for Intake.
- Handles escalated authorization/referral issues in a professional manner, when necessary.
- Maintains a thorough understanding of the revenue cycle which includes insurance requirements, billing, and associated correspondence and is able to independently resolve issues.
- Informs supervisor or manager of any problems or issues when elective procedures aren’t appropriately authorized by the physician office.
- Maintains professional relationships with a wide variety of community providers by facilitating communication and information between clinical and non-clinical personnel.
- Participates in reimbursement, certification and authorization related activities as directed.
- Documents payer and authorization information with the EMR system.
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.
- Other duties as assigned.
MINIMUM REQUIRED QUALIFICATIONS:
- High school diploma or equivalent (GED).
- Two (2) years prior Customer Service, Billing, Account Resolution experience and/or referral coordinator role. Two (2) year prior experience of Revenue Cycle in a Hospital/Medical Office Setting.
- Two (2) year of clerical, customer service, or administrative support experience in a highly customer-oriented organization.
- Two (2) years’ experience in a hospital/health or insurance/payer setting.
- Strong written and verbal communication and organization skills.
- Excellent computer skills including Microsoft Office Products.
- Ability to apply strong analytical qualities.
- Two (2) year of registration experience, point of service collection, insurance validation, understanding of compliance /regulatory guidelines and order release process (es).
- Two (2) year of Epic (or equivalent Electronic Medical Record) experience.
- Prior payer experience.
- Prior logistics experience.
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 a specific stimulus without being distracted by extraneous environmental stimuli. The individual must be able to attend to environmental detail with the ability to separate essential from non-essential or irrelevant stimuli. The attention skills required are generally considered to be automatic - - passive, but focused with an intact capacity for select perception.
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 requirement for autonomous problem solving or creativity of thought in the position is minimal. Problems encountered tend to involve a few concrete variables in or from standardized situations. Typically involves adhering to a chart or set procedure.
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.
Performing under stressful conditions: Ability to perform under stress when confronted with emergency, critical, unusual, or dangerous situations, or in situations in which working speed and sustained attention are critical aspects of the job. Is subject to danger or risk, or to tension as a regular, consistent part of the job.
Variety and change: Ability to perform a variety of duties, often changing from one task to another of a different nature without loss of efficiency or composure involving significant differences in technologies, techniques, procedures, environmental factors, physical demands, or work situations.
Communication: Ability to exchange information with others clearly and concisely; to present ideas, facts and technical information.
Interpersonal relations: Ability to maintain relationships that facilitate task accomplishment; to cooperate and resolve conflicts; to recognize needs and be sensitive of others.
EQUIPMENT USAGE REQUIREMENTS
Equipment/Tools: Computer, Phone, Copier, Printer, Fax, Office Supplies, Intercom, Wireless devices
Software: Microsoft Office Products, Clinical information system
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.
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 08/25/2021