BH Insurance/Precert Specialist

Job Title

Verifies and documents benefit information. Requests initial authorization and meets provider's referral requirements to ensure that optimum payment is made to the hospital and providers.

Essential Functions

• Contacts insurance companies to obtain and verify benefit information, documents all benefit information, and meets payer's referral requirements to ensure that optimum payment to the hospital and providers will be satisfied.
• Obtains insurance prior authorization as needed and documents the verification of benefits and prior authorizations in Epic. Maintains record of pending prior authorizations and documents timely follow-up.
• Assists with the retrospective review of records for patients who have insurance changes that impact the authorization.
• Communicates authorization denials and appeal options to referral sources/Providers. Assists with coverage resources as appropriate.
• Contacts schedulers if insurance cannot be verified and refers self-pay patients to financial assistance resources.
• Participates in department and interdepartmental meetings to promote knowledge, troubleshoot, and resolve issues related to benefits or authorizations.
• Maintains knowledge of The Joint Commission, Medicaid, Medicare, and other third-party payer standards and requirements.

Education Requirement

High school graduate, required.

Associate's Degree, preferred.

Certifications

CPR certification (based on position and as determined by manager).

Skills

Strong computer skills required with the ability to navigate most current technology systems.

Excellent written, communication, and organizational skills required.

Experience

One year previous health care or insurance experience preferred.

Physical Requirements

Occasionally: Bend/twist, Biohazard waste, Blood and/or Bodily Fluids, Chemicals/Medications, Communicable Diseases and/or Pathogens, Driving motor vehicles (work required) *additional testing may be required, Lifting / Carrying: 0-10 lbs, Lifting / Carrying: 11-20 lbs, Loud Noises, Patient Equipment, Pushing / Pulling: 0-25 lbs, Reaching above shoulder, Squat/kneel, Standing, Walking

Frequently: Flexing/extending of neck, Hand use: grasping, gripping, turning

Continuously: Audible speech, Color vision, Computer skills, Decision Making, Depth perception, Hearing acuity, Interpreting Data, Peripheral vision, Problem solving, Repetitive hand/arm use, Seeing Far/near, Sitting

Additional Physical Requirements performed but not listed above:

Able to multi-task within in a stressful environment.

The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet

Nationwide Childrens Hospital