Authorization Specialist | Access Center
2 days ago
Schedule: Monday-Friday 8:30am 5:00pm
At Children's, the region's only full-service pediatric healthcare center, our people make us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team members are supported and deeply valued. Opportunities for career growth abound as we grow our services and spaces, including the cutting-edge Hubbard Center for Children. Join our highly engaged, caring team-and join us in providing brighter, healthier tomorrows for the children we serve. Children's is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.
A Brief Overview
Responsible for pre-certification of outpatient medications on behalf of the organization and designated physicians with third party payers related to medication authorizations. Establishes good rapport with and maintains effective communications with patients, their parents, physicians, nursing staff and third-party payors.
Essential Functions
- Primarily responsible for coordinating the authorizations of inpatient/outpatient procedures.
- Obtains and updates pertinent information, i.e., name of patient, date of admission test or clinic visit, diagnosis, date of birth, primary care MD, Referring MD, Attending MD, admission status when necessary, phone numbers and insurance information in Epic Registration systems to initiate a referral or pre-certification.
- Obtains necessary paper/electronic referrals from Primary Care Physician and/or Specialty Physician when required by payers, Managed Care, and traditional Medicaid and enters information into Epic.
- Assigns referral and pre-certification information to the appropriate visits.
- Obtains and maintains knowledge of requirements for third party payers by website updates, emails, and policy changes.
- Identifies all payment sources by counseling with families, referring physicians, and by utilizing electronic eligibility. Reviews referral and pre-certification requirements/clinical information to prevent denials and/or reduction of benefits and documents in Epic.
- Responsible for contacting family to verify insurance if terminated.
- Obtains and documents authorization numbers from third party payers certifying scheduled procedure, initial days of care and appropriate length of stays if applicable.
- Utilizes Epic work queues to identify upcoming services and determine the need for authorization. Collaborates with Financial Counselors and other parties to obtain signature on "Self-Pay" form for those patients identified with no insurance coverage and to obtain Advanced Beneficiary Notice for services with limited coverage, or on those patients whose insurance coverage is questionable for services/procedures scheduled in advance. Refers/consults with Patient Financial Counselors on any cases which may require financial assistance.
- Consults with referring/ordering physician and family when insurance authorization or coverage is in question 5 days prior to scheduled date or as soon as possible after admission, procedure, or visit is scheduled to allow for MD/patient to determine if visit will be rescheduled, cancelled, or to proceed as scheduled.
- Coordinates with billing department, Supervisor or Lead Authorization Specialist to resolve any authorization related claims issues, including providing input, documentation and assistance in preparing appeals.
- Provides support to all departments including but not limited to all Specialty Clinics and outside physician offices to ensure a timely and accurate authorization process.
- Regular attendance at work is an essential function of the job.
- Perform physical requirements as described in the Physical Requirements section
- High School Diploma Or G.E.D Required and
- Associate's Degree from an accredited college or university in a healthcare field Preferred
- Minimum 2 years' experience in authorizations, medical office setting, or health insurance setting Required
- Good verbal & written skills
- Computer knowledge
- Ability to work with minimal supervision
- Knowledge of ICD-9, ICD-10, HCPCS and CPT-4 coding regulations
- Knowledge of the changing rules and regulations of third-party payors
- Problem solving skills
- Current and valid registration as a Pharmacy Tech with the State of Nebraska is Preferred
Children's is the very best for kids and the very best for your career At Children's, we put YOU first so together, we can improve the life of every child
About Us
Make a meaningful difference improving the lives of children
At Children's, the region's only full-service pediatric healthcare center, our people make us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team members are supported and deeply valued. Opportunities for career growth abound as we grow our services and spaces, including the cutting-edge Hubbard Center for Children. Join our highly engaged, caring team-and join us in providing brighter, healthier tomorrows for the children we serve.
-
Access Specialist
2 weeks ago
Omaha, Nebraska, United States Center for Immigrant & Refugee Advancement Full timeJob Title: Access SpecialistJob Summary:The Center for Immigrant & Refugee Advancement is seeking an Access Specialist to join our team. As an integral part of our legal team, the Access Specialist will play a critical role in client intake and referral, as well as client outreach and education.Key Responsibilities:* Screen participants through intake calls...
-
Authorization Management Specialist
6 days ago
Omaha, United States Amber Specialty Pharmacy Full timeAt Amber Specialty Pharmacy, our commitment to patient care is unmatched. Enjoy fulfillment in a career where you have the opportunity to make a positive impact on patients with complex and chronic conditions. Monday-Friday Hours: 8:00 a.m. - 5:00 p.m. No weekends or evenings Six paid holidays Must pass post-offer, pre-employment drug/background tests as...
-
Patient Access Specialist
4 weeks ago
Omaha, United States Children's Hospital & Medical Center Full timeJob DescriptionSchedule: Monday-Friday 8am to 4:30pm$1000 Hiring bonus!! At Children's, the region's only full-service pediatric healthcare center, our people make us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team members are supported and deeply valued....
-
Patient Access Specialist
3 months ago
Omaha, United States Children's Hospital & Medical Center Full timeJob DescriptionSchedule: 6a-6p one shift per week and every 3rd weekend We're searching for a Patient Access Specialist to Facilitate admission and registration process for all inpatients and outpatients. Obtains essential information for registration and pre-certification, ensures all data is accurate, forms are complete and signed for inpatients,...
-
Intake Specialist
3 months ago
Omaha, United States AdaptHealth LLC Full timeAdaptHealth Opportunity - Apply Today!At AdaptHealth we offer full-service home medical equipment products and services to empower patients to live their best lives - out of the hospital and in their homes. We are actively recruiting in your area. If you are passionate about making a profound impact on the quality of patients' lives, please click to apply,...
-
Poison Center Specialist
1 week ago
Omaha, Nebraska, United States Nebraska Medicine Full timeJob Summary:Nebraska Medicine is seeking a highly skilled Poison Center Specialist to join our team. As a key member of our poison center, you will provide expert advice and guidance to healthcare professionals and consumers about poison exposures. Your exceptional clinical skills and knowledge of toxicology will enable you to make a significant impact in...
-
Patient Access Specialist
4 weeks ago
Omaha, United States Children's Hospital & Medical Center Full timeJob DescriptionScheduled: Hours will vary At Children's, the region's only full-service pediatric healthcare center, our people make us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team members are supported and deeply valued. Opportunities for career growth...
-
RN - Poison Center Specialist
2 weeks ago
Omaha, Nebraska, United States Nebraska Medicine Full timeJob Title: RN - Poison Center SpecialistNebraska Medicine is seeking a highly skilled RN - Poison Center Specialist to join our team. As a key member of our poison center, you will play a vital role in providing expert guidance and support to healthcare professionals and consumers regarding poison exposures.Responsibilities:Provide informational assistance...
-
Health and Wellness Specialist
1 month ago
Omaha, Nebraska, United States Coffee Regional Medical Center Full timeJob Title: Health and Fitness SpecialistCoffee Regional Medical Center is seeking a highly skilled and dedicated Health and Fitness Specialist to join our team. As a key member of our Wellness Center, you will be responsible for providing exceptional care and support to patients and clients of all ages.Job Summary:The Health and Fitness Specialist will be...
-
Senior Identity and Access Management
4 days ago
Omaha, Nebraska, United States The Reserves Network Inc Full timebJob Title:/b Senior Identity and Access Management (IAM) SpecialistbrbrbJob Description:/bbrbrWe are seeking a highly skilled Senior Identity and Access Management (IAM) Specialist to join our team at The Reserves Network Inc. As a Senior IAM Specialist, you will be responsible for administering and developing projects related to IAM, automation, and...
-
Poison Center Specialist
1 week ago
Omaha, Nebraska, United States Nebraska Medicine Full timeJob SummaryNebraska Medicine is seeking a highly skilled RN - Poison Center Specialist to join our team. As a key member of our poison center, you will provide critical information and support to healthcare professionals and consumers about poison exposures.Key Responsibilities:Obtain complete histories, assess poisoning severity, and make appropriate...
-
Education Specialist
1 week ago
Omaha, Nebraska, United States Huntington Learning Center Full timeWe are seeking a dedicated and passionate Education Specialist to join our team at Huntington Learning Center. As an Education Specialist, you will play a vital role in supporting students of all ages in their academic journey. Your expertise in reading, math, writing, study skills, and vocabulary will be invaluable in helping our students...
-
BIM Specialist Data Center Expert
2 weeks ago
Omaha, Nebraska, United States Olsson Full timeJob Title: BIM Specialist Data CenterOlsson is seeking a highly skilled BIM Specialist to join our team in the data center industry. As a BIM Specialist, you will play a crucial role in maintaining accurate Revit and CAD files, collaborating with our BIM team to ensure seamless project delivery.Key Responsibilities:Coordinate the delivery and maintenance of...
-
Education Specialist
1 week ago
Omaha, Nebraska, United States Huntington Learning Center Full timeTeaching Opportunity at Huntington Learning CenterHuntington Learning Center is seeking enthusiastic and dynamic educators to join our team as Supplemental Instructional Support Specialists. As a member of our team, you will work with students in small group settings, providing personalized instruction and support to help them achieve academic success.Why...
-
Family Centered Treatment Specialist
4 days ago
Omaha, Nebraska, United States Better Living - Foster Care & Family Services Full timeJob Title: Family Centered Treatment SpecialistJob Summary: Better Living - Foster Care & Family Services is seeking a skilled Family Centered Treatment Specialist to provide intensive, home-based services to families in crisis. The ideal candidate will have a strong background in family therapy and experience working with children and families.Key...
-
Access Scheduler
5 months ago
Omaha, United States Methodist Health System Full timeWhy work for Nebraska Methodist Health System? At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we serve and people we employ. We call it The Meaning of Care - a culture that has and will continue to set us apart. It's helping families grow by making each delivery special, conveying a difficult diagnosis with a...
-
Senior Identity and Access Management Specialist
2 weeks ago
Omaha, Nebraska, United States The Reserves Network Inc Full timeJob OverviewWe are seeking a highly skilled Senior Identity and Access Management Analyst to join our team at The Reserves Network Inc. This is a unique opportunity to work with a well-respected client headquartered in Omaha, NE.Key ResponsibilitiesDesign, implement, and maintain core IAM security capabilities, technologies, and systems.Serve as a specialist...
-
Patient Access Specialist
3 months ago
Omaha, United States Children's Hospital & Medical Center Full timeJob DescriptionSchedule: 36 hours per week; Monday-Friday, weekend rotation, evenings possible $1,000 Hiring Bonus At Children's, the region's only full-service pediatric healthcare center, our people make us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team...
-
Access Transport Specialist
2 weeks ago
Omaha, Nebraska, United States TrueNet Communications Full timeJob Title: Access Transport TechTrueNet Communications is seeking a skilled Access Transport Tech to join our team in Omaha, NE.Job SummaryThe Access Transport Tech is responsible for provisioning and configuring aggregate devices, routers, optical access, and/or DWDM equipment that carries video, data, and/or telephony traffic. This role requires working...
-
Surgical Nurse Specialist
1 week ago
Omaha, Nebraska, United States Saunders Medical Center Full timeJob SummaryAt Saunders Medical Center, we are seeking a highly skilled and dedicated Surgical Nurse Specialist to join our team. As a key member of our surgical services department, you will be responsible for providing exceptional patient care and support to patients undergoing surgical procedures.Key Responsibilities:Assess and organize patient data to...