Responsibilities
- Tracks and resolves cases in precertification and prior authorization queues by securing required financial approvals per established protocols.
- Stays current with payer-specific rules for pre-authorizations, referrals, and certifications, ensuring compliance in all clearance activities.
- Serves as a knowledgeable resource for navigating internal systems and external payer requirements to secure necessary care approvals.
- Applies effective methods such as online portals, email, fax, and phone to expedite the authorization process.
- Secures and accurately records pre-certifications and prior authorizations in the Epic system before scheduled admissions.
- Works with patients, care teams, and departments to gather needed documentation and insurance permissions ahead of services.
- Engages with patients, providers, and departments like Utilization Review to resolve authorization obstacles.
- Escalates accounts denied or not cleared financially within three days of admission, per department guidelines.
- Maintains up-to-date understanding of Centers for Medicare & Medicaid Services (CMS) regulations and policies.
- Coordinates with patients and financial counseling staff to process Charity Care applications when appropriate.
Benefits
- Comprehensive medical, dental, vision, and pharmacy coverage
- Flexible Spending Account options
- Employer contributions to 403(b) retirement savings
- Payout for accrued earned time
- Paid time off benefits
- Scheduled contract-based pay increases
- Opportunities for professional growth and promotion
- Support programs for employee and family well-being
Work Arrangement
On-site
Other
- Per Diem, Part Time schedule
- Excellent verbal communication skills required
- Ability to work in a complex environment with varying points of view
- Must be comfortable with ambiguity
- Exhibit good decision making and judgment capabilities
- Attention to detail
- Equal Opportunity Employer/Disabled/Veterans
- No job offers extended over text messages or social media platforms
- No requirement to purchase equipment for or prior to employment
- Applications received only through company website
