Healthcare Authorizations Specialist
3 days ago
Overview
As a Healthcare Authorizations Specialist at St. Luke's University Health Network, you will play a vital role in ensuring the financial clearance of all scheduled patients by providing accurate and timely verification of all financial information and precertification/referral for all services to ensure proper reimbursement.
This position requires strong customer service skills, knowledge of health insurances, and the ability to work independently. You will be responsible for reviewing medical necessity of genetic testing/infusion services in addition to prior authorization to ensure revenue for services.
The ideal candidate will have three years of healthcare experience in an outpatient department or business office with a hospital, physician's office, or similar medical facility, and a high school graduate or equivalent degree.
Responsibilities
- Financial Clearance: Responsible for the financial clearance of all scheduled patients by providing accurate and timely verification of all financial information and precertification/referral for all services to ensure proper reimbursement.
- Medical Necessity Review: Reviews medical necessity of genetic testing/infusion services in addition to prior authorization to ensure revenue for services.
- Prior Authorization: Submits prior authorizations for all STAT imaging orders for PCP and Specialty prior to date of service.
- Insurance Referrals: Submits for insurance referrals for all PG Specialty and PCP orders and SL Care Now Departments.
- Epic Work Queues: Utilizes specific Epic Work Queues designed for Prior Authorization and Insurance Referral workflows to ensure correct process is followed for proper documentation and billing in Epic.
- External Provider Notifications: Notifies all external providers of prior authorization requirements for scheduled services.
- Patient Communication: Provides information to patients regarding the prior authorization process, including any necessary steps or documentation required from their end.
- Appeal Letters: Writes appeal letters or retrospective medical review requests.
Requirements
- Education: High school graduate or equivalent.
- Experience: Three years healthcare experience in an outpatient department or business office with a hospital, physician's office, or similar medical facility preferred.
- Customer Service Skills: Strong customer service skills with knowledge of health insurances required.
Estimated Salary: $55,000 - $65,000 per year based on location and experience.
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