Insurance Verification and Authorization Specialist I

:

Kent Campus Hospital

STATUS: Full Time 80 Hours

SHIFT: Day/ Evening

GENERAL SUMMARY:

Summary:

The Insurance Verification and Authorization Specialist I provides high level customer service while performing complete and accurate financial clearance functions to provide information for continuity of care and revenue cycle efficiency. Verifies insurance benefits, makes pre-certification requests, and obtains authorizations for services. The Insurance Verification and Authorization Specialist I performs other duties as assigned to support the department's needs and policy changes.

ESSENTIAL FUNCTIONS & ACCOUNTABILITIES:

1. Request, track and obtain insurance authorizations and pre-certs for patient services within time allotted for treatment for Bayhealth and referring physicians (if appropriate). 2. Ensure request for authorization is timely and handled in accordance with departmental policy and payer requirements. 3. Maintains performance standards. 4. Required to utilize all available resources to verify eligibility, benefit levels, and patient copayment/coinsurance responsibilities. 5. Validates coordination of benefits between insurance carriers 6. Clearly document all communications and contacts with payers, physicians, and families in standardized documentation requirements. 7. Verifies or obtains referring physician authorizations (if appropriate). 8. Validates all diagnosis and procedure codes are accurate and appropriate prior to the delivery of services. 9. Maintain knowledge of insurance company requirements. 10. Screens patients for financial assistance programs and initiates applications. 11. Supports Authorization Specialist II in all duties as assigned within the scope and range of job responsibilities. 12. All other duties as assigned within the scope and range of job responsibilities.

REQUIRED MINIMUM EDUCATION AND CREDENTIAL:

• Education High School Diploma or GED
• Credential None Required

EXPERIENCE:

Required: One year of medical office/insurance clerical experience with prior CPT and ICD-10 coding experience.

Preferred: Two (2) years insurance verification or registration experience in a hospital or physician office.

PREFERRED EDUCATION AND CREDENTIAL:

• Education Associate Degree Business Or Associates Degree in healthcare related field or a graduate of a medical/practical nursing licensed technical program.
• Credential

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