Health Insurance and Authorization Specialist II

Job Description

The Health Insurance and Authorization Specialist is responsible to assess and perform quality control function for all preadmission visits on surgical inpatient, short stay 23 (SS23), Endo and ambulatory procedures ensuring all pertinent information is on file and accurately documented. These activities include review diagnosis and history for correct insurance coverage, insurance eligibility and coverage verification using the three patient identifiers, confirming prior authorization is on file for correct level of care, inquiries on prior auth denials and works with the Provider’s office to resolve, requests estimated cost and collects deposits for non-covered services, ensures appropriate medical justification is documented for out-of-network payers, refers our self-pay patients to Financial Case Management (FCM) for Medicaid assessment or Financial Assistance, reviews and validates MSP questions, monitors Medicare days for exhausted benefits, identifies and resolves coordination of benefits discrepancies, and notifies Utilization Management of additional clinical requests.

$20.99 - $28.34 an hour

City
:
Rochester

Area of Interest
:
Clerical

Employment Status
:
Full-Time

Hours/Week
: 40hrs

• Education:
  
  High school Diploma or equivalent required. Associate degree preferred in related discipline (admitting/registration/patient billing/insurance); or equivalent experience
• Experience:
  
  Minimum of 3 years of related experience preferably in a hospital setting, medical office billing and or knowledge of third-party insurance regulations.
• Skills:
  
  Require high degree of professionalism and motivation with excellent communication and customer service skills, and medical terminology. Good interpersonal and telephone skills. Detail oriented. Computer, copier and FAX skills.