Insurance Authorization Specialist

South County Health is an independent, non-profit healthcare system offering a comprehensive range of advanced inpatient, outpatient and home health services. Accredited by The Joint Commission (TJC), SCH is made up of South County Hospital, South County Home Health, and South County Medical Group. South County Health has received numerous distinctions for patient care and safety over the years, which have included a 5-star rating on HCAHPS scores, a 5-star rating by CMS for overall hospital quality, and A's for hospital quality and patient safety by The Leapfrog Group. Having celebrated over 100 years of service to southern Rhode Island, South County Health offers an exceptional opportunity to provide our patients with the best care possible while enjoying a healthy work-life balance. We offer competitive salaries and an attractive benefits package which includes, health, dental, vision, tuition reimbursement, 403b, PTO, and a broad range of career development benefits and opportunities.

Job Summary:

The Insurance Authorization Specialist assists with components of the revenue cycle, most importantly insurance verifications prior to services performed and claim submission. In addition, the Specialist is responsible for ensuring that South County Hospital has the appropriate insurance Pre-certifications, Pre-authorizations, Insurance Notifications, and Treatment Requests prior to the provision of an exam, procedure, or hospitalization for both inpatient and outpatient services. The Specialist is also accountable for verifying that the pre-certification/pre-authorization matches the services that were actually performed. Additionally, the Specialist is the primary on-site liaison for the ancillary departments to referring providers' offices, insurance carriers, as well as patients regarding pre-certification/pre-authorization verification. Performs follow up on insurance verifications when unable to obtain it real time or when patients fail to bring their ID card at time of service.

Minimum Qualifications:

Minimum three (3) years related experience is required. Proficient in Microsoft Excel and Word and strong typing skills. Excellent verbal and written communication skills. Strong customer service skills. Understanding and ability to utilize various electronic, web based, and manual coding resources. Knowledge of scheduling programs, telephone, and database systems. Knowledge of medical terminology and third party insurance. Strong knowledge of insurance verification processes, health care coding systems (procedural, diagnosis, modifier, remittance, and others).


Pay Starting at: $20.25