Authorization/Insurance Specialist - York - (full-time) - Days

York, PA | Clerical and Administrative | Tracking Code: 52578

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General Summary:

 

 


Under the general supervision of the Supervisor-Insurance Specialty Center and Director-WSH Access, 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:

1 Performs online and telephone authorization verification for outpatient imaging procedures and infusion procedures.
2 Contacts provider offices to obtain authorizations and referrals as needed.
3 Obtains authorizations for outpatient imaging procedures ordered by the facility providers as needed.
4 Maintains appropriate documentation in Eclipsys and on the authorization spreadsheets.
5 Notifies imaging sites of financial waivers or ABNs that must be signed at least two hours prior to testing or infusion.
6 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.
7 Answers phone calls regarding authorizations or referrals.
8 Completes audit slips for registration errors.
INSURANCE VERIFICATION DUTIES:
9 Performs online and telephone authorization verification for surgical patients, patients considering pulmonary rehabilitation, and patients undergoing other medical procedures.
10 Sends patient letters documenting co-pay and deductible information.
11 Obtains authorizations for outpatient surgeries and invasive outpatient procedures that do not use the PHAS process.
12 Maintains appropriate documentation in Eclipsys.
13 Receives patient co-pay and deductible payments in the mail. Documents the payments in Eclipsys and prepares the deposit of these funds.
14 Assists pre-registration staff with insurance questions as needed.

 

Department Description:


The Insurance Specialty Center is a centralized WellSpan health department located in a beautifully restored loft building known as the Greenway Tech Building in downtown York.  The personal work spaces are state of the art with ergonomic design, dual 19 inch monitors, natural lighting and task lighting to assist staff with workflow and ensure a comfortable working atmosphere.


 


This department supports an exceptional patient experience by focusing on ensuring that any test, service or procedure that is referred or performed by a WellSpan Provider or Facility has the appropriate authorization and coverage information to ensure adequate reimbursement.

Required Experience

Minimum Education:              

 

High School or G.E.D.

 

 

Minimum Experience:           

 

1 – 2 years of medical insurance experience

                                            

 

Required Course(s)/Training:       

 

Medical terminology within 6 months of hire


Quality of Life

WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization is comprised of a multispecialty medical group of more than 1,200 physicians and advanced practice clinicians, a regional behavioral health organization, a home care organization, six respected hospitals, more than 15,000 employees, and 140 patient care locations. WellSpan is a charitable, mission-driven organization, committed to exceptional care for all, lifelong wellness and healthy communities. We are committed to transforming the health of the communities we serve and to educating the next generation of clinicians, staff and leaders.

Quality of Life
Quality of Life

Founded in 1741, the city of York is considered by many as the first capital of the United States. The Articles of Confederation were signed by the Second Continental Congress here in 1777. Its beautifully restored historic district is an architectural treasure. While York retains its farming and manufacturing heritage, at its heart York is a thriving cultural community that has attracted creative talent and innovative entrepreneurial investors from across the nation.

Life in York County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, semi-professional baseball team, fine dining and more — within an easy drive of major East Coast cities.

York County residents can find local employment in healthcare, manufacturing, technology, agricultural and service sectors. (Patient population: 445,000)

Equal Opportunity Employment

WellSpan Health is an equal opportunity employer. Employment selection and related decisions are made without regard to sex, race, age, disability, religion, national origin, color or any other protected class. WellSpan Health does, however, have a tobacco-free/nicotine-free hiring policy.

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