Insurance Authorization Coordinator (Finance)

Nemours Children's Health is seeking an Insurance Authorization Coordinator I for our Pediatric Specialty Outpatient Clinic in Pensacola, Florida. This is a full-time position. Work schedule is Monday through Friday during normal daytime business hours.

The Insurance Authorization Coordinator is responsible for obtaining authorizations for hospital-based and/or physician-based services.

The Coordinator utilizes work queues & other mechanisms to initiate the authorization and/or referral, follow-up, monitor appointments add-ons, and document any changes available for the initial authorization and/or referral request. Authorizations/Referrals for services are to be completed based on the departmental goals and guidelines set. The position is required to utilize all available resources to verify eligibility, authorization requirements and plan benefit levels. Detailed benefit collection process to ensure capture of patient responsibility to include all financial out to pocket cost to patient/parent. Process supports and ensures more accurate financial collections.

Qualifications:

• High School diploma required
• At least 6 months of insurance authorization experience required
• Knowledge of insurance plans and third-party payor requirements
• Understanding of CPT, ICD 10 codes and basic medical terminology required
• Knowledge of, but not limited to, role appropriate Epic Applications preferred

Essential Functions:

Authorization Coordination: Ability to request and obtain preauthorization for assigned specialties and ability to cover for other workflows including work queue items. This will involve submitting required documentation, following up on requests to ensuring timely approvals.

Ensure request for authorizations and notifications are worked timely and handled in accordance with departmental policy and payer requirements. Following all documentation requirements.

Insurance Verification: Verify patients' insurance coverage, eligibility, demographics, benefits and financial responsibility to determine if prior authorization is required for specific medical procedures or treatments; additionally any predetermination requirements to ensure proper payment for service to support collection accuracy & efforts.

Policy Knowledge: Stay up to date with insurance policies, guidelines, and procedures related to authorization and reimbursement processes. This includes understanding specific requirements for different insurance companies and their medical coverage policies.

Properly process appointment or appt add-ons, changes to previously scheduled services, date changes, and or impactful service changes in need of immediate review.

Follow administrative review process if a service does not have an insurance authorization outside of the department's standard timeframe.

Communication: Communicate with patients, their families, and healthcare professionals to provide updates on the status of authorization requests, address questions or concerns, and ensure a smooth process for all parties involved.

Promptly review clinical documentation for necessary information to submit to the payer along with authorization request.

Documentation and Record-Keeping: Maintain accurate and detailed records of authorization requests, approvals, denials, and any related correspondence. This includes documenting patient information, insurance details, and the authorization process itself.

Compliance: Adhere to relevant laws, regulations, and privacy guidelines when handling patient information and insurance-related documentation. Ensure all authorization processes are conducted ethically and in accordance with organizational policies.