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Insurance Authorization Coordinator

2 months ago


Salem, Massachusetts, United States Salem Hospital, Inc. Full time

About Salem Hospital, Inc.
Salem Hospital, an affiliate of Mass General Brigham, is dedicated to enhancing patient care, research, education, and community service. We prioritize diversity, equity, and inclusion, aiming to reflect the varied backgrounds of the patients we serve. At Mass General Brigham, we advocate for equal access to quality healthcare, employment, and advancement opportunities, embracing the full spectrum of human diversity, including race, gender, sexual orientation, ability, religion, ethnicity, and national origin.

Position Overview
Reporting to the PAS Manager, the Authorization/Pre-Certification Specialist (APS) plays a crucial role in ensuring that patient demographics and financial details are accurately captured in the hospital's registration system. This position involves direct collaboration with patients, physician offices, the Central Billing Office, and third-party payers to determine eligibility and secure insurance authorizations and pre-certifications for various admissions and procedures.

Key Responsibilities

  • Collaborate with team members to obtain necessary insurance authorizations for both elective and emergency admissions and procedures, ensuring timely submission of required documentation.
  • Verify and assign accurate diagnosis and procedure codes to align with the secured authorizations.
  • Ensure comprehensive and precise patient demographic and financial information for all types of admissions, including day surgeries and outpatient encounters.
  • Refer patients to the Financial Counseling Department when financial obligations cannot be met.
  • Communicate potential health insurance authorization issues to patients and admitting physicians prior to service dates, coordinating the authorization process in compliance with payer regulations.
  • Document and manage the insurance authorization process status within the hospital's registration system to facilitate timely billing.
  • Analyze and address denial trends in collaboration with the Denials Coordinator to enhance hospital revenue.
  • Maintain high standards of accuracy and quality in individual assignments while supporting team productivity.
  • Adapt to new electronic systems and software as necessary, balancing training with ongoing work responsibilities.

Qualifications
High School Diploma or GED equivalent is required. Candidates must possess strong English communication skills, both oral and written, along with excellent organizational abilities and multitasking skills. A proactive approach to problem-solving and the ability to work under pressure are essential. Candidates should demonstrate a positive attitude and be effective team players. Proficiency in typing (minimum 40 WPM) and familiarity with computer applications, including Microsoft Outlook, Word, and Excel, are also required.

Equal Employment Opportunity Statement
Salem Hospital is an Affirmative Action Employer. We embrace diverse skills, perspectives, and ideas, and we are committed to ensuring that all qualified applicants receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, or any other status protected under law.