Newton-Wellesley Hospital(NWH)
Preauthorization Specialist
Newton-Wellesley Hospital(NWH), Newton Lower Falls, MA, United States
Job Summary:
Underthe direction of the Financial Coordinator Supervisor, ensures that all information necessary for properfinancial reimbursement for high dollar patient care is analyzed and submittedto insurance companies for approval prior to the patient's date of service. Collaborateswith insurance companies and physician offices when necessary to verifyeligibility and authorization requirements to ensure financial reimbursementfor services.
Essential Functions:
Qualifications
Qualifications:
Education
EEO Statement
Newton-Wellesley Hospital will provide equal employment opportunities to all applicants and employees without regard to race, color, religion, gender age, national origin, disability, marital status, genetic information, veteran or active military status, gender identity or expression, or sexual orientation.
Underthe direction of the Financial Coordinator Supervisor, ensures that all information necessary for properfinancial reimbursement for high dollar patient care is analyzed and submittedto insurance companies for approval prior to the patient's date of service. Collaborateswith insurance companies and physician offices when necessary to verifyeligibility and authorization requirements to ensure financial reimbursementfor services.
Essential Functions:
- Performall insurance verification for eligibility, coverage, and authorizationrequirements via Web or phone with third party payers.
- Ensuresall possible coverages are created and verified, through electronic ormanual methods, and all discrepancies are resolved. Validates thatcoverages are assigned to appropriate visit. -Collects and validatesorder-related information including office visit, radiology and surgicalorders. Follows up with ordering provider to verify CPT codes.
- Escalateschallenging accounts to team lead to ensure accounts are approved at priorto patient appointment/surgery. Escalates non-certified urgent cases toappropriate clinical departments and leadership for approval to proceed orcommunicate rescheduling.
- Contacts providers andinsurance companies to validate data, collect missing information and resolveinformation discrepancies, -Understands clinical guidelines for payorsrequiring authorization to better build cases for authorization requests andprovide feedback to clinical departments on required notes.
- Workclosely with physician offices obtaining authorization for inpatient andoutpatient services
Qualifications
Qualifications:
Education
- Highschool graduate or equivalent; some college preferred
Experience - 1-2 years of insurance, third party payor or secretarialexperience in a health care setting required
Knowledgeand Skills - MedicalTerminology required
- Analyticalability to gather and interpret data and communicate desired outcomes orallyand in writing in a professional manner
- Strongcommunication and interpersonal skills
- Abilityto handle multiple duties
EEO Statement
Newton-Wellesley Hospital will provide equal employment opportunities to all applicants and employees without regard to race, color, religion, gender age, national origin, disability, marital status, genetic information, veteran or active military status, gender identity or expression, or sexual orientation.