PHYSICIAN LIAISON

Job Title

Insurance Authorization Specialist

Job Description

The primary purpose of this position is to ensure that appropriate authorization and reimbursement resources are in place for elective services provided. This includes the following: verification of order received from physician and verification of insurance information provided, accurate and timely determination of authorizations required; validate that required authorizations are obtained and monitored for appropriateness of the procedure. Adherence to government and non-government program requirements; effectively communicating with Scheduling and Patient Access the authorization/program requirements for their elective procedure, personal payment liabilities if known, and options for care and placement that allow for informed decisions by the patient and his/her family while protecting the financial interest of Seton Medical Center. Provides information to Scheduling and Patient Access when authorizations are delayed, denied for rescheduling procedures when no other options are available.

Responsibilities

Demonstrated expertise in insurance authorization confirmation and follow-up. Demonstrated knowledge of Patient Access, Medical Records, and related departments all have on the impact of reimbursement. Ability to work well with a variety of positions, including physicians, nurses, Patient Access and Patient Financial Services staff. Proficient with Microsoft Office Suite, AS400 applications, and database management. Ability to utilize software applications to maximize automation and efficiency. Able to learn new software applications and/or programs as needed.

Qualifications

Minimum of 1 year experience working with Commercial Insurance, Medi-Cal and Medicare insurance verification, pre-authorizations and authorizations preferred.