Scheduling & Auth Specialist . Children's Hospital

Overview

Job Summary: The Scheduling & Auth Specialist 2 is responsible for financially clearing insurance verifications for all services and patient financial classifications, reviewing medical records, interfacing with payers to extend authorization for treatment, collaborating with the Patient Business Office (PBO), assisting with reimbursement and authorization according to contracts, and supporting the denials and appeals process. Obtains pertinent documentation to support authorization requests.

Serves as the liaison between PBO, Central Authorization, physicians, outside medical groups (OMG), various insurance carriers, patients, and all departments for office visits, in-patient and out-patient services. Performs other duties as needed.

• Financially clear insurance verifications for all services and patient financial classifications.
• Review medical records and interfaces with payers to extend authorization for treatment.
• Collaborate with the Patient Business Office (PBO) and assist with reimbursement and authorization according to contracts.
• Support the denials and appeals process and obtain pertinent documentation to support authorization requests.
• Serve as liaison between PBO, Central Authorization, physicians, OMGs, insurance carriers, patients, and all departments for office visits, in-patient and out-patient services.
• Perform other duties as needed.

• Associate's Degree required. Minimum three years of related experience required. Minimum one year of healthcare experience preferred. Experience may be considered in lieu of degree.

• Knowledge of various insurance types and their guidelines, including the ability to read and interpret EOBs.
• Working knowledge of current ICD and CPT coding systems.
• Keyboard at least 40 wpm.
• Read, write legibly; speak English with professional quality; use computer, printer, and software programs necessary to the position (e.g., Word, Excel, Outlook, PowerPoint).
• Operate/troubleshoot basic office equipment required for the position.
• Essential Interpersonal
  
  Skills:
  
  Able to relate and communicate positively, effectively, and professionally with others; work calmly and respond courteously when under pressure; collaborate and accept direction.
• Able to communicate effectively in English in person, in writing, and on the telephone; think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision.
• Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone; identify and distinguish various sounds associated with the workplace; see adequately to read computer screens and written documents necessary to the position.

• Medical coding certification preferred.