As one of the nation’s leading pediatric health care systems, Nemours is committed to providing all children with their best chance to grow up healthy. We offer integrated, family-centered care to more than 300,000 children each year in our pediatric hospitals, specialty clinics and primary care practices in Delaware, Florida, Maryland, New Jersey and Pennsylvania. Nemours strives to ensure a healthier tomorrow for all children – even those who may never enter our doors – through our world-changing research, education and advocacy efforts. At Nemours, our Associates help us deliver on the promise we make to every family we have the privilege of serving: to treat their child as if they were our own. 

Equity, diversity, and inclusion guide our growth and strategy.  We are looking for individuals who are passionate about, and committed to leading efforts to provide culturally relevant care, reducing health disparities, and helping build a diverse and inclusive team environment. All Nemours associates are expected to ensure that these philosophies are embedded in their day to day work with colleagues, patients and families.

The Authorization Specialist - Therapeutic Services is responsible for accurate and complete patient accounts based on departmental protocol, policies and procedures, and compliance with regulatory agencies, to include but not limited to pre-registration and registration functions, timely and accurate appointment scheduling, check-in and co-pay collection. Ensure all insurance requirements are met prior to patients' arrival, and inform patients of their financial liability.

This position has high customer service with our patients, payors and physicians by phone and in-person and requires excellent customer service skills.

Qualifications:

• Medical scheduling or insurance verification experience preferred; Knowledge of insurance and coverage


• High School Diploma or equivalent required

Primary Responsibilities:

• Greets patients and families in person or by phone.


• Maintains a friendly and welcoming atmosphere in a busy and public work environment.


• Maintains patient confidentiality.


• Collects and documents accurate patient demographics and insurance information.


•  Analyzes insurance coverage and benefits for service to ensure timely reimbursement.


•  Obtains all prior authorizations as appropriate based on insurance plan contracts / guidelines and documents in EPIC system per policy and procedure.


• Enters and updates referrals as required.  


•  Communicate with insurance carriers regarding clinical information requested and to resolve issues relating to coverage and payment for specific patients and benefits.


•   Notifies families of insurance limitations or potential out of pocket costs for requested services.


•   Facilitates referral to Financial Services for payment sources for uninsured patients.


•  Schedules and assists with coordinating appointments for multiple disciplines and with outside vendors as appropriate by program.       


• Systematically collects consents and other required documents (real-time)


• Verify insurance cards and other important documents (real-time)


• Collects and posts co-pays, any past due balances, and reconciles money at the end of the shift, as required by program


• Schedules follow-up appointments as needed


• Handles triage of “walk down “appointments for scheduling and insurance approvals.


• Works collaboratively with clinical staff, Central Business Office, financial counselors etc to assure coverage and payment are obtained for all services rendered.


• Identifies trends and alerts managers and supervisors to plan benefit changes that may affect services.


• Appropriately communicates with a variety of contacts (patients, parents, physician, clinicians, patient relations, translators etc).


• Must have ability to work well with others.


• Regular attendance required.


• Excellent written and verbal communication skills are required

Our dedication to professionals who are dedicated to children frequently earns Nemours a spot on the list of top workplaces in the communities we serve. Our Associates enjoy comprehensive benefits, including our unique “Bridge to a Healthy Future” pediatric health plan, an integrated wellness program, opportunities for professional growth, and much more. As an equal opportunity employer, Nemours focuses on the best-qualified applicants for our openings.