Insurance and Authorization Specialist

Employment Type: Full time Shift: Day Shift Description: Job Description Summary Come join our Patient Access team at Saint Francis Hospital, a member of Trinity Health Of New England! We are part of the nationwide Trinity Health family bringing compassionate care to our communities. Job Description: This position is primarily responsible for obtaining and verifying all OP and IP authorizations for Hospital setting. As well as ensuring appropriate prior authorization for related services, drugs, treatments and supplies. The scope of prior authorizations may include (but is not limited to) consults, diagnostic testing in office procedures and pharmaceuticals including off label drugs, and drugs for clinical trials. Top Reasons to Work at Trinity Health of New England: · Our Mission and Core Values · Great benefits and Health Insurance Coverage · Career growth and advancement potential · Award-winning Hospitals and Departments Work Hours/Shift: · Full-Time - 40 hours per week You Will Be Responsible For: · Excellent Communicator: Prepares accurate reports and provides departmental summary information for Patient Access Team that ensures all infusions and testing performed in the department are reviewed and prior auth or predetermination is obtained. · Technical Familiarity: Appeals denied claims for related services, drugs, treatments and supplies. Obtains authorizations for related services, drugs, treatments and supplies. · Active Teamwork: Assists interdepartmental teams in troubleshooting accounts that are being held in A/R due to lack of prior authorization. Requirements: · Minimum High School graduate or equivalent, Associates Degree preferred. · Preferred certification in CCS, CCS-P, CPC, or specialty coding. · Three to five years’ experience in a health care environment with exposure and knowledge of the patient population and types of services patients receiving. Prior authorization experience involving ancillary testing desirable. · A strong understanding of HIPAA laws and requirements as they relate to review and reporting of documentation. · Knowledge of managed care and third-party payer benefits designs and reimbursement requirements. · Knowledge of ICD-9 and ICD-10 coding and documentation requirements. · Proficient in Microsoft Office applications including Outlook, Word, and Excel. Preferred experience in EPIC or comparable EMR system · Strong analytical skills with attention to detail and high degree of accuracy in order to produce reports, analyses, and other detail as requested · Strong communication skills. Attention to detail. Knowledge of drug regimens and associated regulations/policies/procedures applicable to insurance coverage and the associated payment for and appeal of procedures/billing rejected. · Two years of experience in reviewing medical records for National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) About Trinity Health Of New England: Trinity Health Of New England is an integrated health care delivery system that is comprised of world-class providers and facilities dedicated to full spectrum preventative, acute, and post-acute care. We aim to deliver top level care to increase our community's overall health at lower costs. While we serve nearly 3 million people, we are proud to be a part of a national system that focuses on putting our patients first and having the best colleagues to do so. Trinity Health Of New England benefits include health insurance, adoption assistance, tuition reimbursement, paid vacation, sick time, and professional advancement just to name a few. Employees can also take advantage of extra benefits specific to each hospital. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by federal, state or local law. Our Commitment to Diversity and Inclusion Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions. Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity. Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions. Based in Livonia, Mich., and with annual operating revenues of $17.6 billion and assets of $24.7 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Committed to those who are poor and underserved in its communities, Trinity Health is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services — ranked by number of visits — in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs. For more information, visit www.trinity-health.org. You can also follow @TrinityHealthMI on Twitter.

Salary : $18 - $25