Insurance Specialist I

Work Shift:

Day Shift

Time Type:

Full time

Department:

CC017115 Outpatient Prior Authorizations

Summary:

Monday to Friday, 8:00 a.m. to 5:00 p.m. - Onsite

Additional Information:

Responsible for the pre-verification of insurance for patients being admitted into the hospital for care. Ensures insurance coverage, resolves any issues with coverage and escalates complicated issues. Verifies, interprets, coordinates, disseminates insurance information; establishes and counsels patient on co-payments, maintains charge capture information.

Required Education:

No education requirements

Recommended Education:

High school diploma or GED or equivalent

Required Work Experience:

Entry Level - Experience not Required.

Recommended Work Experience:

Required Certifications:

Recommended Certifications:

Description

1. Obtains pre-authorization approvals for outpatient procedures from the Surgery, Day Medicine, Radiology, Nuclear Medicine, Genetics, Sleep lab and Heart Station departments.

2. Preregisters, obtains prior authorization, price estimates, PCP referrals, upfront collections and referred accounts prior to date of service.

3. Obtains prior authorizations and insurance verification for all clinics, Medicare patients, out-of-state Medicaid, SDC and for specialty drugs.

4. Obtains the appropriate prior authorizations for surgical and outpatient procedures and the necessary CPT/ICD-10 diagnosis codes when appropriate.

5.Obtains price estimates, upfront collections and referred accounts prior to date of service.

6.Completes outbound calls to families regarding insurance coverage and benefits, high deductibles, co-pays, denials.

7. Conducts appropriate follow-ups and verifications on all assigned accounts including documenting in the patients account detailed insurance information prior to services being rendered.

8. Ensures that pre-certifications, pre-notifications, prior authorizations or referrals are received for each account with a financial class of insurance and/or Medicaid.

9. Appropriately refers all high dollar or self-pay accounts to Financial Counselor.

10. Serves as a liaison between the clinical staff and insurance payers.

11. Collects deductible, co-pay and all other applicable payments.

12. Performs other duties as assigned.

Arkansas Children's (https://www.archildrens.org/about-us) is the only hospital system in the state dedicated to caring for children, which enables us to uniquely shape the landscape of pediatric care in Arkansas.

Arkansas Children's is driven by four core values-safety, teamwork, compassion and excellence-which inform every action.

Arkansas Children's Hospital has received Magnet Status (https://www.archildrens.org/about-us/magnet-recognition) from the American Nurses Credentialing Center (ANCC), for nursing excellence and patient outcomes. And we are nationally ranked by U.S. News & World Report (https://www.archildrens.org/about-us/awards-and-recognition) for Cancer, Cardiology & Heart Surgery, Diabetes & Endocrinology, Nephrology, Neurology & Neurosurgery, Pulmonology & Lung Surgery and Urology.

For more than a century, Arkansas Children's has met the unique needs of children. But we're more than just a hospital treating sick kids-our services include two hospitals, a pediatric research institute, foundation, clinics, education and outreach, all with an unyielding commitment to making children better today and healthier tomorrow.

Arkansas Children's Little Rock campus includes a 336-bed hospital with the state's only pediatric Level 1 Trauma Center, burn center, Level 4 neonatal intensive care and pediatric intensive care, as well as a nationally-recognized transport service. And Arkansas Children's Northwest (https://www.archildrens.org/locations/arkansas-childrens-nw) provides inpatient and emergency care, clinic rooms and diagnostic services to children in that corner of the state.

"Arkansas Children's is a place of hope and comfort for children and parents. When you are at children's, you are part of an elite team united with a common goal of saving children and making their lives better." Michael - Business Operations Manager

"Arkansas Children's Hospital is a prestigious institution that cares for children." Linda - Information Systems Analyst

"We are an organization of care, love, and hope while we champion children." Angela - Parking and Fleet Coordinator

"Care, love, and hope for children" Kathy - Administrative Assistant

"When I think of my time here at Arkansas Children's Hospital, I can honestly say that it has given me a unique perspective on the human condition, and the various roles that we all have in patient care. As a supply assistant, I have a very important job ensuring that the doctors and nurses have what they need to provide the world class medical care to the Children of Arkansas and surrounding states. Being a Champion for Children is more than a catch phrase, it is a way of life" Nick - Supply Assistant

Arkansas Children's provides equal employment opportunity to all persons without regard to age, race, color, religion, national origin or citizenship status, disability, military status, sexual orientation, gender identity or expression, pregnancy or any other category protected by federal, state and local laws. Further, Arkansas Children's will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant.