Insurance Pre-Authorization Specialist

2 months ago

Delta, United States Delta Health Full time
Description

Delta Health offers health care professionals and people from all walks of life an opportunity to find fulfillment in their jobs as part of a close-knit team.We pride ourselves on ourpositive work culture . Our team members understand our fundamental commitment to the community and rally around the motto "Excellence, Every Patient, Every Time."When you embark on a journey with us, you'll take pride in your work and the impact you have, while building a career with focus and purpose.

Insurance Pre-Authorization Specialist is responsible for providing high quality pre-authorization duties by pre-certifying and pre-authorizing procedures per insurance guidelines.Specialist will be responsible for the completion of the required authorization process by obtaining and verifying insurance coverage.All payers will be called and to include secondary or tertiary to retrieve the appropriate authorization prior to scheduling.Oversees the process of incoming patient orders and obtains information necessary to complete the pre-authorization of an order. This process includes collecting all the necessary

documentation, contacting the referring physician or their office for additional information or to ask questions regarding the order.Main responsible is for the completion of the required pre-authorization process by obtaining commercial insurance and Medicare/Medicaid payment approval prior to the scheduling of an order.

Must possess positive interpersonal skills to effectively communicate and cooperate in a consistently high level with a strong team work ethic.Specialist must be able to interact professionally with medical staff, clinical staff, insurance companies and the public.Regularly projects an image of professionalism in communication, appearance and conduct.

  • Determines if patient's insurance is a part of the provider network
  • Verifies diagnosis code on patient billing is accurate and meets medical necessity
  • Makes outgoing calls or goes online to insurance companies for pre-certification or any authorization
  • Receives pre-authorization from insurance companies and documents in the appropriate system (Meditech or Athena), the authorization number, reference number, person they spoke to, date and a statement to say they let the correct department know it's been approved or denied.
  • Contacts patient and referring offices using HIPAA guidelines prior to scheduled exam

    when additional insurance information is needed
  • Accurately enters a variety of information including date schedule requests received, patient name, referring physician and procedures into computer system.
  • Maintains positive interactions with referring offices, patients and staff
  • Communicates with customers to request additional documentation as needed
  • Assists with denied claims to resolve issues.
  • Pre-authorization Specialist must be able to interact with patients, insurers and DCMH team members in a responsible professional and ethical manner. Also must possess the ability to work in a high volume fast-paced environment with the ability to continuously work with sensitive and confidential information. Employee must be able to function effectively in a team oriented environment.
  • Must be able to work independently with limited direction with sound judgment, initiative and a high degree of accuracy in approvals. Denials will be monitored monthly.
Requirements
  • High school diploma or equivalent
  • 1-2 years previous health care experience working with a variety of health insurance plans for pre-certification and authorization of benefit coverage
  • Prior billing, Medicare and private pay experience preferred
  • Familiar with Medical Terminology
  • Must have one year (1) of customer service experience
  • Must be able to type at an adequate speed to obtain accurate job performance
  • Must have the ability to read, write and speak the English language


Summary

Delta Health is a county-wide healthcare system that has been serving the Western Slope for over 100 years. We have grown to a 49-bed hospital with locations throughout Delta County. We proudly provide a wide range of medical services that meet the diverse needs of our community members. At all stages of life, we are here to provide remarkable care in a healing environment.

Employee Benefits: Medical, RX, Dental, Vision, Retirement, PTO, and Scholarships towards continued education.

Medical: Low monthly premiums; 100% coverage for all services provided within our Delta Health System without a deductible or co-payment. We offer alternative coverage to include massage, acupuncture, and chiropractic care. Employer paid Life and Disability coverage.

Paid Time Off: 4 plus weeks of vacation (CAL) a year for Full-Time employees including sick pay and personal time off.

Retirement: 403B Plan -Up to a 3% retirement match.

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