Insurance Authorization Specialist

4 days ago

Lancaster, PA, United States Pennsylvania Medicine Full time

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Summary:

  • To ensure payment from insurance companies for services provided as well as an extraordinary experience for the patient, this role provides complete and accurate patient insurance verification for hospital and outpatient hospital services. The role also handles non-clinical referrals.
Responsibilities:
  • Coordinate pre-authorization process
  • Confirm the authorization is on file in a timely manner.
  • Liaise with doctor's offices, insurance representatives, Financial Services personnel (PFS), and other departments across the organization to ensure authorization and/or referrals for services on file and accurate with the payer resulting in maximized reimbursement.
  • Consistently identifies and resolves deficiencies with customer registration issues including but not limited to: insurance inquiries, CPT code changes and patient status changes.
  • Manages and resolves coverage and authorization issues from intake to final resolution.
  • Analyzes and researches all escalated authorization/referral issues in a professional manner.
  • Maintains a thorough understanding of the revenue cycle including: insurance requirements, billing standards, and associated correspondence to be able to independently resolve issues.
  • Maintains professional relationships with a wide variety of community providers.
  • Consistently documents appropriate information in department-designated sections of EMR regarding insurance and authorization.
  • Analyzes and researches denials to resolve denied claims with the appropriate payer and/or provider office.
  • Provides missing or additional information to expedite the resolution of the denied claim.
  • Evaluates denied claims to determine when appeals are warranted and collaborates with the appropriate payer and/or practice to resolve issue.
  • Evaluates processes/procedures to continuously improve job functions striving for the best outcomes for the five pillars of LEAN.
  • Helps foster an environment of continuous improvement by suggesting ideas to leadership.
  • Participates in shadowing experiences with payer representatives, other departments and provider.
Credentials:
Education or Equivalent Experience:
  • H.S. Diploma/GED (Required)
  • Education Specialization: Equivalent Experience:
  • Associate of Arts or Science
  • Education Specialization: Equivalent Experience: •Prior experience with authorizations. •1+ years experience in a healthcare related administrative or billing setting.
We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

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