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Job description
Insurance Authorization SpecialistUnder direct supervision, performs all eligibility, verification and authorization requests required for all infusion, oncology and Dance Center patients. Responsible to obtain ongoing authorizations to secure reimbursement of services. Acts as liaison with insurance companies' utilization review departments to ensure all insurance company policies are met. Works collaboratively with the billing team to ensure coverage for dates of service for all patients. Ensures monthly re-verification of all infusion patients. Continuously reviews and remains compliant with ever-changing information from insurance companies. Provides ongoing reporting to management regarding status and challenges encountered.Education: High School Diploma or GED Licensures/Certifications: Not Applicable Experience: 3 years of progressive insurance authorization experience preferred. Epic experience desired.Skills:Thorough knowledge of authorization processesBasic understanding of insurance policies/proceduresDetail oriented with excellent telephone, analytical, organization and time management skillsCollaboration with clinical staff regarding challenging patient needsBasic understanding of complete revenue cycleKnowledge of ICD-10 and CPT coding practicesStrong computer skills, including EMR knowledge and Microsoft OfficeSkill in data analysis and interpretationStrong interpersonal skillsAbility to work in a fast-paced environment and meet frequent deadlinesAbility and initiative to plan for and complete daily activities with minimal directionAbility to assist with process and procedure developmentPrincipal Duties and Responsibilities:Contacts insurance carriers to verify patient's insurance eligibility, benefits, and authorization requirements for specific treatment plans.Collaborates with members of all care teams to ensure effective communication regarding all commercial insurance issues.Facilitates problem-solving with clinical departments, providers, referral sources, insurance companies, and authorization staff.Accurately obtains insurance authorization for patients whose status requires a change in medication dose and/or treatment plan.Comprehensively documents insurance discussions in the Epic referral to communicate up to date details with colleagues.Works closely with Infusion staff, Pharmacy Team, Patient Financial Services, Dance Center staff and Physician/APP to minimize denials and obtain authorizations in a timely manner. Prioritizes authorization requests according to medical urgency.Reviews medical records for submission to insurances, abstracting information from patient medical records pertaining to patient treatments, procedures, and guidelines as required.Reviews patient treatment plan including frequency and dosage prior to treatment and reviews the applicable payer reimbursement criteria to ensure that the specific payer's medical necessity criteria are met.Monitors approval, authorization, and/or pre-determination for all chemotherapy and non-chemotherapy infusion drugs administered when applicable. Reviews the department appointment report daily to ensure that all authorizations are valid and works to re-authorize any expired authorizations 3 days prior to scheduled appointment.Quickly and courteously responds to concerns from patients, staff, and others involved in patient care while maintaining a respectful demeanor. Conducts outbound calls to patients and providers for patient support. Accepts inbound calls from patients and providers to provide support. Follows departmental standards to document all calls.Promptly identifies and resolves all operational issues affecting insurance verification and authorization to ensure a smooth workflow from order creation to billing. Works closely with nursing staff to ensure that patients are scheduled in a timely manner.Maintains internal processes to comprehensively track authorization requirements by patient and follows up as appropriate utilizing established Epic work queues.Maintains current knowledge of payers' requirements for pre-authorizations, certifications and verifications.May perform other duties as assigned.All roles must demonstrate GBMC Values:RespectTreats others with fairness, kindness, and respect for personal dignity and privacyListens and responds appropriately to others' needs, feelings, and capabilitiesExcellenceMeets and/or exceeds customer expectationsActively pursues learning and self-developmentPays attention to detail; follows throughAccountabilitySets a positive, professional example for othersTakes ownership of problems and does what is needed to solve themAppropriately plans and utilizes required resources for various job dutiesReports to work regularly and on timeTeamworkWorks cooperatively and collaboratively with others for the success of the teamAddresses and resolves conflict in a positive waySeeks out the ideas of others to reach the best solutionsAcknowledges and celebrates the contribution of othersEthical BehaviorDemonstrates honesty, integrity and good judgmentRespects the cultural, psychosocial, and spiritual needs of patients/families/coworkersResultsEmbraces change and improvement in the work environmentContinuously seeks to improve the quality of products/servicesDisplays flexibility in dealing with new situations or obstaclesAchieves results on time by focusing on priorities and manages time efficientlyPay Range $19.92 - $29.87Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs.Equal Employment OpportunityGBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.
Worksite address
cockeysville, MD, 21030, US
Who can apply
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