What are the responsibilities and job description for the Authorization specialist position at Nemours?
Nemours is seeking a Hospital Authorization Specialist to join our team. Remote, must be in driving distance to the Main Hospital in Wilmington, DE should there be a need for an occasion to report to the office Essential Functions
- Ensure request for authorization is timely and handled in accordance with departmental policy and payer requirements.
- Accurately verify patient demographics, insurance eligibility, benefits, and financial responsibility.
- Ability of request and obtain preauthorization for assigned specialties and be able to cover for other specialties including workqueues, preadmissions, estimates, etc.
- Build and maintain professional, cooperative relationships with all departments that have direct or indirect impact on obtaining authorizations.
- Contact families in person or by phone contact to obtain necessary information and assist them with insurance issues and / or handle direct PA and DE Medicaid newborn enrollment.
- Prepare estimates for scheduled services. Must interpret patient's benefits correctly for accurate estimates.
- Clearly document all communications and contacts with payers, physicians, and families in standardized documentation requirements including proper format.
Communicate effectively, timely and professionally in writing and verbally.
- Collaborates with Financial Services for newborn enrollment, Medicaid enrollment / re-enrollment, self-pay referrals, estimates and Nemours funding.
- Follow all newly implemented workflows including those developed by Continuous Improvement projects. Participation in CI projects may be required as Supervisor / Manager determines. Additional Requirements
- Authorization experience required.
- High School Diploma required. Specialized (1 year of training beyond high school)
- Minimum 6 months of experience required. Nemours Children's Health offers a comprehensive and competitive benefit package which includes :
- Medical / Dental / Vision Insurance
- Tuition Reimbursement / Continuing Education Support
- 403(b) Retirement Plan
- Paid Time Off (PTO), VTO (Volunteer Time Off) and 6 paid holidays
- Professional / Clinical growth opportunities
- Work Life Benefits
Last updated : 2024-08-30
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