Insurance Authorization Specialist Per Diem
NorthShore University HealthSystem - Niles, Illinois, United States, 60714![NorthShore University HealthSystem](/api/image?src=https%3A%2F%2Fgeneral-board-default.s3.us-east-2.amazonaws.com%2Fpublic%2Fimages%2Fdesk-360x180.webp&w=640&q=75&f=webp)
Work at NorthShore University HealthSystem
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Job Summary:Under the management of the Manager, Patient Access, the Pre-Certification Representative I is responsible to determine insurance eligibility and, as appropriate benefits, pre-authorization / pre-certification and medical necessity requirements based on patient specific insurance. The Pre-Certification Representative I provides this service to ensure that our customers are provided a high quality experience which includes understanding of patient responsibility and ease of access to clinical services. This is achieved through coordination with and education of the patient. The Pre-Certification Representative I helps to insure that patient satisfaction and loyalty are achieved while hospital and Medical Group revenue is optimized.
What you will do:Use NorthShore protocol to verify patient selectionPerforms online eligibility and benefit checks for applicable payers as outlined in guidelines.Enters data accurately into Epic in accordance with standards.Calls the insurance company directly to obtain required eligibility and benefit information for all managed care, governmental and commercial payers,Verifies if pre-certification is required.Process accounts according to performance standards - timing, volume and qualityUse NorthShore protocol to verify patient selectionUtilize established protocols to register patient (e.g. select insurance and guarantor, verify/enter demographic information)Provide instructions to patient (e.g. prep instructions related to procedure, location, co-pay)Accesses Medicare LMRP software to determine if ABN (Advance Beneficiary Notice) is required.Ascertain medical necessity requirements for visit utilizing NEBO Eligibility Software.If medical necessity check fails, contact physician for more appropriate diagnosis if available.Generate and complete ABN when needed and contacted the ordering physician and patient as outlined in procedural guidelines to communicate and explain requirement.For pre-registered patients, fax the ABN to the responsible check-in area (department or registration) for the serviceDocument all activities in Epic appropriately.Process accounts according to performance standards - timing, volume and qualityContacts physician office or insurance company to check status of and / or obtain existing precertification number for ordered service.Documents obtained information including certification number and number of days approved for inpatients into Epic.If authorization is not obtained as required, contact physician office and department regarding cancellation of procedure.If authorization is not obtained due to medical necessity, contact ordering physician's office and patient regarding waiver requirement.Generate and forward waiver as needed to department for patient signatureFollows standards for documenting cases and forwarding to Financial Counseling.Identify if callers have an existing NorthShorConnect accountIf not, introduce NorthShoreConnect and encourage patient useUtilize Epic to create NorthShoreConnect account for patientsApply HIPAA guidelines to all situations, as appropriateFollow all NorthShore protocols to ensure compliance with HIPAAWhat you will need:High School Required1 year of experience in a contact center, healthcare environment or customer service role.Experience with referrals and pre-certification strongly preferred.Strong attention to detail to accurately enter data and research and resolve questionsAbility to utilize multiple computer applications and operating system concurrentlyAbility to recognize customers' anger and attempt to defuse itKnowledge of medical terminology and health insurance terminology, preferredFront desk/central scheduling and/or registration experience, preferredEpic experience, preferredBenefits:Career Pathways to Promote Professional Growth and DevelopmentVarious Medical, Dental, and Vision options, including Domestic Partner CoverageTuition ReimbursementFree Parking at designated locationsWellness Program Savings PlanHealth Savings Account OptionsRetirement Options with Company MatchPaid Time Off and Holiday PayCommunity Involvement OpportunitiesEndeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. For more information, visit www.endeavorhealth.org.When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.Please explore our website (www.endeavorhealth.org) to better understand how Endeavor Health delivers on its mission to "help everyone in our communities be their best".Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.Diversity, equity and inclusion is at the core of who we are; being there for our patients and each other with compassion, respect and empathy. We believe that our strength resides in our differences and in connecting our best to provide community-connected healthcare for all.EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.