Authorization Specialist | Access Center

4 weeks ago

Omaha, United States Children's Hospital & Medical Center Full time
Job Description

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
Education Qualifications
  • High School Diploma Or G.E.D Required and
  • Associate's Degree from an accredited college or university in a healthcare field Preferred
Experience Qualifications
  • Minimum 2 years' experience in authorizations, medical office setting, or health insurance setting Required
Skills and Abilities
  • 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
Licenses and Certifications
  • 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.

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