Hospital Authorization Specialist at Nemours in Wilmington, Delaware

Job Description:

Temporary position for 6 months.

Monday through Friday 8:30-5 (flexible)

Remote position, must be able to report to Wilmington if needed

The Hospital Authorization Specialist I is responsible for obtaining authorizations for hospital-based scheduled services but may also include physician-based appointments.

The Specialist will be assigned to a workqueue to initiate the authorization, follow-up, monitor add-ons, and update an authorization with changes to the original authorization request. The timeframe to complete an authorization for all scheduled services must be within department guidelines.

The Specialist will use all available resources to complete authorization requests and verify eligibility. The associate will need to fully understand how to interpret benefits when verifying eligibility in order to complete an estimate or when speaking to a patient or patient's family.

Essential Functions:

Ability to request and obtain preauthorization for assigned specialties and be able to cover for other specialties including workqueues, preadmissions, and estimates.

Ensure request for authorizations and notifications are worked timely and handled in accordance with departmental policy and payer requirements. Follow all documentation requirements.

Utilize payer tools to determine if an authorization is required. Review payer's clinical guidelines when necessary.

Understand the financial impact of services not authorized or incorrectly authorized.

Appointment or case add-ons, changes to previously scheduled services, date changes, and patient class changes will need an immediate review.

Follow administrative review process if a case does not have an insurance authorization outside of the department's standard timeframe.

Promptly review clinical documentation for necessary information to submit to the payer along with authorization request.

Accurately verify patient demographics, insurance eligibility, benefits, and financial responsibility.

Clearly document all communications and contacts with payers, physicians, and families in standardized documentation requirements including proper format. Communicate effectively, timely and professionally in writing and verbally.

Collaborates with the Central Business Office, Financial Services, Transport, Patient Cost Estimation, Managed Care, Utilization Review, Physician Authorization Department, and other departments that have impact on obtaining authorizations and/or reimbursement.

The Specialist will attend and participate in daily departmental huddles to report on payer issues, barriers affecting workflows, and specific issues that could result in a non-reimbursable or canceled service.

The Specialist must be organized, work effectively in a virtual team environment, can problem solve, and seek assistance when needed.

Build and maintain professional, cooperative relationships with contacts from specialty departments. Consistently demonstrates excellent, empathetic, and knowledgeable customer service skills to internal and external customers.

1-8 years authorization experience required.

Revenue Cycle related certification. Ie. CRCR preferred

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