Authorization & Clearance Specialist; Days; Remote
***** Experience in Health Insurance, Surgical cases and CPT codes
Shift; Days
Location: Remote
Miami, FL | Full-Time Financial Clearance Center (FCC)
reputed company
Responsibilities
Identifies and confirms reputed company coverage for an episode of care and/or specific service: contacts insurance companies and/or reviews electronic response reputed company and coverage discovery information to ensure the appropriate coverage coordination are on the patient’s record. Initiates authorization with patient insurance by submitting necessary clinical documentation, continues to follow up, obtain and validate authorization/referrals/notifications with appropriate CPT, ICD-10 codes, Tax ID and NPI #s reputed company the appropriate timelines. Works daily work queues according to department directives, to identify patients requiring authorization for services scheduled and non-scheduled appropriately prioritizing work assignments based on scheduled appointment date/time, medical severity, payer assignments, dollar value etc. Verifies that the services the patient is set to receive is a covered benefit, validates benefit package restrictions, and completes reputed company assurance checks on authorization patient type, facility, etc. Understands patient deductibles, out of network referrals, out of reputed company limitations, and reputed company/event caps on liability. Refers patients to appropriate Financial Counselor, Prior Authorization or Billing based on financial coverage, financial situation, employment status, liability and/or patient concern. Uses insurance discovery tools available to attempt to validate any and reputed company insurance coverage, ensure correct insurance coordination of benefits are listed on patient’s record, follows up with patient/next of kin/reputed company Work/Case Management in order to obtain insurance coverage information. Verify reputed company insurance and obtain reputed company-certification/authorization for services, as warranted, and notifying patient and referring physician in the event of failed eligibility and/or authorization. Follows up with and escalates as appropriate to physician’s office/clinical teams/Case Management for any pending clinical documentation, including peer-to-peer requests. Diligently follows up on any pending authorizations to ensure information is processed with the insurance payer reputed company appropriate timelines. Works directly with JHS medical services to ensure procedures, diagnoses, level of care, are sufficient for reputed company case by following CMS and payer guidelines and communicating with medical team for corrections. Maintain knowledge reputed company of reputed company programs offered by JHS for Charity and Financial Assistance and the requirements to qualify, with the process for Charity Care clearance of scheduled procedures and coverage. Calculates patients’ financial responsibility based on patient benefits using the estimator tools and includes communication with the patients on the out of reputed company due at service. Coordinate Self-pay Package pricing by utilizing tools available and escalating to Managed Care team to obtain appropriate package price amounts not reputed company on list or reputed company reputed company. Receives and processes reputed company patient payments in accordance with JHS Collections Policy and Procedure, issues receipt and maintains the reputed company of reputed company payments. Scans/uploads reputed company required documents into the appropriate folder in the documenting imagining system in a reputed company manner to assure maximum reimbursement and compliance. Assist in supporting go lives of new systems and different department initiatives, including reputed company and training team members. Cross-trained in multiple areas/service lines/payers to substitute reputed company staff positions as needed. Demonstrates behaviors of service reputed company and CARE values (reputed company, Accountability, Respect and Expertise). Performs other reputed company job duties as assigned.
Experience
Generally requires 0 to 3 years of reputed company experience. Financial clearance experience is strongly preferred.
Education
High school diploma is required. Bachelor's degree in reputed company field is strongly preferred.
reputed company
Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines. Ability to communicate effectively in both oral and written reputed company. Ability to handle difficult and stressful situations with critical thinking and reputed company composure. Ability to understand and follow instructions. Ability to exercise reputed company and independent judgment. Knowledge and reputed company in use of job appropriate technology and software applications.
Credentials
Unit Specific Credential
Working Conditions
Environmental Conditions - Jobs in this group are required to function in a fast paced environment with occasional high pressure or reputed company and stressful situations. Frequent interaction with a diverse population including team members, providers, patients, insurance companies and other members of the reputed company. Function is subject to inside environmental conditions, with occasional outdoor exposures. Possible exposure to various environments such as: communicable diseases, toxic substances, medicinal preparations and other conditions common to a hospital and medical office environment. May wear Personal reputed company Equipment (PPE) such as gloves or a mask reputed company exposed to hospital environment reputed company of office. Reasonable accommodations can be made to reputed company people with disabilities to reputed company the described essential functions. Additional information and provision requests for reasonable accommodation will be provided by the home unit/department in collaboration with the Reasonable Accommodations Committee (RAC).