Insurance Authorization Specialist - Horizon Healthcare Services
3310 Horizon Health Services Operations
Patient Account Services
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8:30am-5:00pm Monday-Friday. Every 8th Saturday with the prior Monday off.
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.
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 02/11/2021