What are the responsibilities and job description for the ADMISSIONS AUTHORIZATION SPECIALIST position at Mt. Washington Pediatric Hospital?
JOB SUMMARY
The Admissions Authorization Specialist is responsible for assisting in the completion of tasks and assignments related to facilitating the admission process. Including but not limited to, processing requests for insurance verifications and authorizations using website portals and outbound phone calls for all insurance payers prior to admitting to MWPH.
ESSENTIAL FUNCTIONS OF POSITION
- Excellent knowledge of healthcare industry in regard to the revenue cycle, coding, claims, and generally accepted insurance benefit terms and processes.
- Working knowledge of medical terminology, medical insurance and medical billing
- Obtains and / or reviews patient insurance information and eligibility verification to obtain authorizations for admission to Mt Washington Pediatric Hospital.
- Knowledge of the processes to perform reviews and attain payment status for state insurance carriers utilizing telephone and internet
- Accurately delegates proper CPT and ICD-9 / 10 codes to ensure payments and approvals
- Provides insurance company with clinical information necessary to secure authorization and approvals
- Copying, faxing, filing, computer entry of admission data, assisting in 3808 / 1288 form completions
- Maintenance of admission and financial files as well as ensuring a clean well supplied and functioning environment.
- Provides relief coverage for other clerical aspects within the department.
- Participate in performance improvement initiatives, data tracking and collection for analysis.
- Functions with a focus on customer service.
- Handles phones, messages and mail in a timely manner.
- Consistently maintains timely and accurate documentation in the Medical Record as well as communication with the necessary parties regarding authorization activity related to each case.
- Completing Face to Face interviews with families of new admits to complete all required Admission / Payment documentation.(This will occasionally require the usage of translators in person or via electronic device.)
- Daily reporting of insurance authorization processing time, per insurance carrier, via workable system spreadsheet.
- When required, submitting insurance authorization request for retro services provided.
POSITION REQUIREMENTS
Educational Requirements
Knowledge, Skills and Abilities
REPORTING RELATIONSHIPS
Supervision Received
Reports to the Admissions Manager
Supervision Exercised
None
INTERPERSONAL RELATIONSHIPS
TOOLS / EQUIPMENT USED
PHYSICAL ENVIRONMENT / WORKING CONDITIONS
This job description identifies the general nature and level of work to be performed. It is not to be considered an exhaustive list of responsibilities, duties or skills required of an incumbent.
Updated 01 / 14 / 2025
