Authorization/Ins Spec I

Job Description:

Under general supervision, this position performs a variety of support functions for each assigned facility including, but not limited to, monitoring imaging and infusion schedules to ensure authorizations have been obtained and answering calls regarding referrals and authorizations; or, insurance verification, obtaining authorizations, mailing patient responsibility letters, and receiving payments through the mail. Possesses a working knowledge of insurance requirements and restrictions.

Duties and Responsibilities

Essential Accountabilities:

1. AUTHORIZATION DUTIES:
2. Performs online and telephone authorization verification for outpatient imaging procedures and infusion procedures.
3. Contacts provider offices to obtain authorizations and referrals as needed.
4. Obtains authorizations for outpatient imaging procedures ordered by the facility providers as needed.
5. Maintains appropriate documentation in Eclipsys and on the authorization spreadsheets.
6. Notifies imaging sites of financial waivers or ABN’s that must be signed at least two hours prior to testing or infusion.
7. Contacts patients the evening prior to their procedure if authorization is not obtained to give them the option of rescheduling their study or signing a financial waiver.
8. Answers phone calls regarding authorizations or referrals.
9. Completes audit slips for registration errors.

1. INSURANCE VERIFICATION DUTIES:
2. Performs online and telephone authorization verification for surgical patients, patients considering pulmonary rehabilitation, and patients undergoing other medical procedures.
3. Sends patient letters documenting co-pay and deductible information.
4. Obtains authorizations for outpatient surgeries and invasive outpatient procedures that do not use the PHAS process.
5. Maintains appropriate documentation in Eclipsys.
6. Receives patient co-pay and deductible payments in the mail. Documents the payments in Eclipsys and prepares the deposit of these funds.
7. Assists pre-registration staff with insurance questions as needed.

Qualifications

• Minimum Experience:
  • 1 – 2 years of medical insurance experience
• Minimum Education:
  • High School or G.E.D.
• Required Courses:
  • Medical terminology within 6 months of hire