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SalaryMajor Responsibilities:
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
- The Authorization Specialist is responsible for verifying insurance benefits/eligibility for Commercial and Managed Care carriers for patients accessing hospital services
- 1)Verifies insurance benefits/eligibility for primary, secondary and tertiary insurance plans.
- 2)Utilizes Managed Care and Insurance web sites for determining eligibility and benefits.
- 3)Refers uninsured accounts to the Patient Financial Counselor.
- The Authorization Specialist is responsible for obtaining authorization and pre-certification for services from Commercial and Managed Care carriers for patients accessing hospital services
- 1)Accurately collects and analyzes insurance, financial, and clinical data from multiple sources, and obtains other information necessary for authorization, pre-certification and billing purposes.
- 2)Initiates telephone calls to the Primary Care Physician (PCP) or designee to obtain referral authorization and/or pre-certification for services.
- 3)Initiates electronic and/or telephone inquiries to insurance carriers for authorization and/or pre-certification for services
- 4)Contacts referring physician and appropriate clinical staff of unauthorized services.
- 5)Initiates communication with patients desiring services not authorized by their insurance carrier. Explains potential financial implications and responsibilities for services that are not authorized.
- 6)Initiates communication with patients desiring out-of-network hospital services. Explains potential financial implications and responsibilities for out-of-network services.
- 7)Refers patients to insurance carrier for explanation of benefits and details regarding their benefit plan.
- The Authorization Specialist is responsible for entering insurance benefits/eligibility, demographics, and pre-certification/authorization information in the patient accounting system
- 1)Ensures accuracy of benefit/eligibility information and carrier codes.
- 2)Processes demographic corrections as appropriate.
- 3)Completes data collection fields in the patient accounting system.
- 4)Electronically records information on a timely basis. 5)Accurately prepares required electronic and hard copy forms, documents, and reports necessary for registration and billing of services.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
