Insurance Authorization Specialist

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This position is responsible for financial clearance of the patient account which includes initiating insurance verification, notification, pre-certification, authorization and obtaining reference numbers (as appropriate) for all Inpatient, Observation and Outpatient Services. Counsels the patient regarding their financial obligation, insurance benefits and appropriately communicate the patient liability. Acts as a liaison for the patient, physician office, care management team, community agencies and the Revenue Service Center.

  • Verifies the ordering clinician credentials for add on outpatient encounters if not verified by the scheduling department at the time of scheduling.
  • Works daily reports to ensure all payer specific billing requirements and authorization requirements are met.
  • Obtains and verifies necessary demographic and billing information and updates that information in the eSummit system.
  • Collects amounts owed for medical services including contacting the patient to secure payment.
  • Assists with the follow up on appeals, denials, answer inquiries and update accounts as necessary.
  • Identifies problems and communicates with the Revenue Service Center, Care Management team, Payer Relations and insurance companies in a timely manner.
  • Remains flexible in scheduling to meet department and organizational needs to accommodate the scheduling process.
  • Responsible for meeting productivity and quality measures.
  • All associates of SCL Health System are expected to meet the following in their day-to-day work:
    1. Be available to work as scheduled and report to work on time.
    2. Be available to work overtime if needed.
    3. Be willing to accept supervision and work well with others.
    4. Be respectful of all with whom you interact and act in a professional manner.
    5. Be well groomed and dressed appropriately for your role.
    6. Be in compliance with all SCL Health System policies.
    7. Be sufficiently rested to perform your duties throughout the period assigned.
    8. Demonstrate a willingness to learn.
    9. Be able to communicate clearly, think clearly, and concentrate on assigned tasks.
    10. Be willing to perform other duties as assigned.

The information above is for summary purposes and is not intended to be a comprehensive list of essential functions.

  Minimum Required Preferred (Optional)
Education High School Diploma or Equivalent  
     Additional Detail    
Experience More than 1 year and less than 3 years More than 3 years and less than 5 years
     Additional Detail Two or more years in a hospital medical office or insurance experience. Three or more years collection experience
Licensure, Certification
or Registration
  CHAA (Certified Health Access Associate)
Other: Knowledge,
Skills and Abilities
Knowledge of state Medicaid/Medicare programs
Knowledge of payment assistance/charity programs
Knowledge of payer requirements for authorization and billing
Knowledge of ICD-9, ICD-10 and CPT coding
Effective interpersonal and communication skills, including written, verbal and email etiquette.
Proven customer service/problem solving skills.
Proficient computer skills with MS Office products, including Outlook, Word and Excel.
Knowledge of HIPAA regulations

General knowledge of hospital billing preferred
Medical Terminology preferred

Other combinations of formal education, training and experience may be considered.

Organization: Corporate, Various Locations
Primary Location: CO-Denver/Boulder/Surrounding Areas-Broomfield
Department: SYS-RSC Pre Access
Schedule: Full-time
Shift: Day Shift
FTE: 1
Job Number: 17010128
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