Reports to the Registration Manager or the Emergency Care Center (ECC) Manager. Follows established Beacon policies and procedures to verify insurance coverage to ensure necessary procedures and hospitalizations are covered by an individual's provider. The Insurance Verification Authorization Specialist will assure authorization is obtained for all procedures and diagnostic testing to services being rendered. The Authorization Specialist will also initiate the authorization for direct admissions, emergency admissions, and emergency procedures. They will work closely with medical staff, clinical staff, referring clinics, Centralized Scheduling, Surgery Scheduling, Social Services, and Utilization Review departments. They will be responsible for communication with insurance carriers and/or providers for purposes of obtaining approval for services requiring authorization, pre-certification, and prior approval for admissions to Beacon or Epworth Center by using web based tools, other electronic means where possible, or by telephoning and faxing when necessary. Coordinating those visits with the correct paperwork and insurance verification, along with accurate documentation in the patient's medical record is essential. They will answer high volume of incoming phone calls as well as making high volume of outbound phone calls, with constant communication to the Utilization Review, Social Services, and Surgery Scheduling departments. Performs other clerical duties as necessary.
MISSION & VISION
Mission: To enhance the physical, mental and emotional well-being of the communities we serve as the community's provider of outstanding quality, superior value and comprehensive health care services.
Vision: Our vision is to achieve:
Innovative health care and well-being services of the highest quality at the greatest value
Easy access and convenience
Outstanding patient experiences
Ongoing education involving physicians, patients and the community
Education and Experience
The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a high school diploma (or equivalent). A minimum of two years of experience in a hospital or physician practice business office is required. Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills required. A medical terminology course must be successfully completed prior to employment. Associate's Degree preferred. Medical prior authorizations or claims experience in a managed care setting and CHAA certification are highly preferred.
Knowledge & Skills
Requires basic office and keyboarding skills (with the ability to type a minimum of 40 wpm) and the ability to use designated reference materials and office equipment (i.e., computer, printer, fax machine, calculator, etc.).
Requires effective telephone skills (for example, to accurately take and relay information about patients, physician orders and referrals).
Demonstrates proficient computer skills (i.e., data entry, word processing and spreadsheets). Requires the ability to use multiple databases (such as Pathways Healthcare Scheduling, RelayHealth, Cerner and MCA Compliance Checker).
Requires a complete understanding of time of service collections. Specifically, must understand why it is necessary and must be able to effectively communicate this to Beacon's patient community as necessary.
Requires extensive knowledge of medical terminology, private insurance coverage (and managed care), insurance networks, ICD10, and CPT codes.
Demonstrates the interpersonal skills necessary to interact effectively with patients from various backgrounds in a professional, enthusiastic, courteous, friendly, caring and sincere manner. Also demonstrates the ability to maintain effective working relationships with other departments, physicians and their office staff.
Demonstrates the verbal communication skills needed to communicate in a clear and effective manner when communicating with insurance companies, other departments, and physician offices.
Good listening skills are required. Sensitivity to individuals who do not speak English as their first language is expected.
Requires the ability to strictly follow Beacon's policy on confidentiality. Also requires the ability to be aware of the need to lower one's voice in certain situations.
Requires ability to utilize good judgment and maintain one's composure in stressful situations.
Requires the basic math skills needed to calculate patient's insurance benefits such as deductible, coinsurance, and out of pocket.
Works in an office environment. Also may work in patient care areas with possible exposure to bio-hazards.
Requires a flexible work schedule (including evenings, nights and weekends) that meets the needs of the Department.
Must be effective in a quality-focused, multi-priority environment that frequently deals with stressful situations and important deadlines and schedules.
Requires the physical ability and stamina (i.e., to walk moderate distances, climb stairs, lift up to 15 pounds, reach, bend, stoop, twist, etc.) to perform the essential functions of the position.