9 Insurance Authorization Specialist Jobs in Philadelphia, PA
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Insurance Authorization Specialist
$42k-52k (estimate)
Full Time
6 Days Ago
Good Shepherd Rehab is Hiring an Insurance Authorization Specialist Near Philadelphia, PA
* JOB SUMMARY
*Acts as a liaison with all insurance providers including commercial, managed care, and governmental plans
* Gathers and submits patient information to secure prior authorizations for inpatient IRF and LTACH admissions
* Gathers and transmits required documentation to the Medicare Administrative Contractor as required by CMS in the setting of demonstration projects and audits
* Assures accuracy of authorizations including program identifiers and level of care
* Communicates the need for peer-to-peer discussions and/or member appeals as necessary in the case of denied authorization requests
* Researches authorization related denials, determines cause and resolution, and communicates with hospital billing for corrected claim submission
* Acts as a patient advocate between the patient and their insurance plan
* Provide support with verification of patient benefits and eligibility as needed
* ESSENTIAL FUNCTIONS
* PATIENT / CUSTOMER
* Essential Accountabilities
* Maintain compliance with HIPAA regulations.
* Act as a patient advocate between the patient and the insurance plan.
* Develop and maintain strong collaborative relationships with insurance providers.
* Recognize time sensitive nature of obtaining prior authorizations.
* Accurate and timely communication of authorization status to Clinical Liaison, Admission, and Case Management teams.
* Conduct real-time and retrospective chart audits for CMS compliance.
* Contributes to a positive work environment and to the overall efforts of the Patient Access and Case Management teams.
* Non-Essential Accountabilities
* Perform other duties in the scope of payer relations as assigned.
* PATIENT/ EMPLOYEE SAFETY ACCOUNTABILITIES
* Participates in Entity and Department wide initiatives for Patient /Employee safety.
* Demonstrates an awareness of patient/ employee safety when carrying out daily responsibilities.
* Regular validation of competencies as related to tasks required for the position.
* OPERATIONS
* Essential Accountabilities
* Direct communication with Clinical Liaison and Admission teams to determine need for patient prior authorization via daily meetings, email, text and phone.
* Obtain necessary demographic and clinical information to support prior authorization via PennChart, patient records, and with direct communication with Clinical Liaison and Admission team.
* Maintain contact list for prior authorization and utilization management representatives with contracted insurance providers.
* Secure prior authorizations for patient admissions via insurance provider portal and phone, or as directed by insurance provider.
* Communicate status of authorization to Clinical Liaison, Admission, and Case Management teams in a timely manner.
* Communicate the need for peer-to-peer discussions and/or member appeals as necessary in the case of denied authorization requests.
* Investigate claim denials for authorization related issues, determine cause, and contact insurance provider for resolution.
* Conduct real-time and retrospective chart audits as needed to determine compliance with payer regulations.
* Verify patients' insurance benefits and eligibility for services via insurance provider portal and phone, or as directed by insurance provider, as needed.
* Remains current with Managed Care and Payer Relations updates.
* Remains current with CMS updates affecting the IRF and LTACH programs.
* Partner with Penn Medicine and GSRN Managed Care teams to develop Single Payor Agreements (SPAs) as needed.
* Verify prior authorizations are provided with the correct NPI and program identifiers for the IRF and LTACH programs.
* Accurately record authorizations and related notes in the Electronic Medical Record for billing procedures.
* Non-essential Accountabilities
* Promotes available services of the GSPP IRF and LTACH.
* Participates in GSPP unit-based committees as needed.
* QUALIFICATIONS:
* To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
* Education
* High School Diploma required
* Associate's Degree preferred
* Work Experience
* 1 -2 years in health insurance authorization or verification process; hospital experience preferred
* Licenses / Certifications
* N/A
*
* Gathers and submits patient information to secure prior authorizations for inpatient IRF and LTACH admissions
* Gathers and transmits required documentation to the Medicare Administrative Contractor as required by CMS in the setting of demonstration projects and audits
* Assures accuracy of authorizations including program identifiers and level of care
* Communicates the need for peer-to-peer discussions and/or member appeals as necessary in the case of denied authorization requests
* Researches authorization related denials, determines cause and resolution, and communicates with hospital billing for corrected claim submission
* Acts as a patient advocate between the patient and their insurance plan
* Provide support with verification of patient benefits and eligibility as needed
* ESSENTIAL FUNCTIONS
* PATIENT / CUSTOMER
* Essential Accountabilities
* Maintain compliance with HIPAA regulations.
* Act as a patient advocate between the patient and the insurance plan.
* Develop and maintain strong collaborative relationships with insurance providers.
* Recognize time sensitive nature of obtaining prior authorizations.
* Accurate and timely communication of authorization status to Clinical Liaison, Admission, and Case Management teams.
* Conduct real-time and retrospective chart audits for CMS compliance.
* Contributes to a positive work environment and to the overall efforts of the Patient Access and Case Management teams.
* Non-Essential Accountabilities
* Perform other duties in the scope of payer relations as assigned.
* PATIENT/ EMPLOYEE SAFETY ACCOUNTABILITIES
* Participates in Entity and Department wide initiatives for Patient /Employee safety.
* Demonstrates an awareness of patient/ employee safety when carrying out daily responsibilities.
* Regular validation of competencies as related to tasks required for the position.
* OPERATIONS
* Essential Accountabilities
* Direct communication with Clinical Liaison and Admission teams to determine need for patient prior authorization via daily meetings, email, text and phone.
* Obtain necessary demographic and clinical information to support prior authorization via PennChart, patient records, and with direct communication with Clinical Liaison and Admission team.
* Maintain contact list for prior authorization and utilization management representatives with contracted insurance providers.
* Secure prior authorizations for patient admissions via insurance provider portal and phone, or as directed by insurance provider.
* Communicate status of authorization to Clinical Liaison, Admission, and Case Management teams in a timely manner.
* Communicate the need for peer-to-peer discussions and/or member appeals as necessary in the case of denied authorization requests.
* Investigate claim denials for authorization related issues, determine cause, and contact insurance provider for resolution.
* Conduct real-time and retrospective chart audits as needed to determine compliance with payer regulations.
* Verify patients' insurance benefits and eligibility for services via insurance provider portal and phone, or as directed by insurance provider, as needed.
* Remains current with Managed Care and Payer Relations updates.
* Remains current with CMS updates affecting the IRF and LTACH programs.
* Partner with Penn Medicine and GSRN Managed Care teams to develop Single Payor Agreements (SPAs) as needed.
* Verify prior authorizations are provided with the correct NPI and program identifiers for the IRF and LTACH programs.
* Accurately record authorizations and related notes in the Electronic Medical Record for billing procedures.
* Non-essential Accountabilities
* Promotes available services of the GSPP IRF and LTACH.
* Participates in GSPP unit-based committees as needed.
* QUALIFICATIONS:
* To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
* Education
* High School Diploma required
* Associate's Degree preferred
* Work Experience
* 1 -2 years in health insurance authorization or verification process; hospital experience preferred
* Licenses / Certifications
* N/A
Job Summary
JOB TYPE
Full Time
SALARY
$42k-52k (estimate)
POST DATE
06/22/2024
EXPIRATION DATE
07/11/2024
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The following is the career advancement route for Insurance Authorization Specialist positions, which can be used as a reference in future career path planning. As an Insurance Authorization Specialist, it can be promoted into senior positions as an Admitting Supervisor that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Insurance Authorization Specialist. You can explore the career advancement for an Insurance Authorization Specialist below and select your interested title to get hiring information.
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