Preauthorization Specialist

Job Description - Preauthorization Specialist (3303447)Job Summary:Under the direction of the Financial Coordinator Supervisor, ensures that all information necessary for proper financial reimbursement for high dollar patient care is analyzed and submitted to insurance companies for approval prior to the patient’s date of service. Collaborates with insurance companies and physician offices when necessary to verify eligibility and authorization requirements to ensure financial reimbursement for services.Essential Functions:Perform all insurance verification for eligibility, coverage, and authorization requirements via Web or phone with third party payers.Ensure all possible coverages are created and verified, through electronic or manual methods, and all discrepancies are resolved. Validate that coverages are assigned to appropriate visit. Collect and validate order-related information including office visit, radiology and surgical orders. Follow up with ordering provider to verify CPT codes.Escalate challenging accounts to team lead to ensure accounts are approved at prior to patient appointment/surgery. Escalate non-certified urgent cases to appropriate clinical departments and leadership for approval to proceed or communicate rescheduling.Contact providers and insurance companies to validate data, collect missing information and resolve information discrepancies. Understand clinical guidelines for payors requiring authorization to better build cases for authorization requests and provide feedback to clinical departments on required notes.Work closely with physician offices obtaining authorization for inpatient and outpatient services.Work collaboratively with Case Management for all patients’ financial issues and updating accounts.Qualifications:Education:

High school graduate or equivalent; some college preferred.Experience:

1-2 years of insurance, third party payor or secretarial experience in a health care setting required.Knowledge and Skills:Medical Terminology required.Analytical ability to gather and interpret data and communicate desired outcomes orally and in writing in a professional manner.Strong communication and interpersonal skills.Ability to handle multiple duties.Newton-Wellesley Hospital will provide equal employment opportunities to all applicants and employees without regard to race, color, religion, gender age, national origin, disability, marital status, genetic information, veteran or active military status, gender identity or expression, or sexual orientation.Primary Location

MA-Newton-MGH Newton Wellesley HospitalWork Locations

MGH Newton Wellesley Hospital2014 Washington StNewton 02462Job

Admin/Clerical/CustService-OtherOrganization

Newton-Wellesley Hospital (NWH)Schedule

Full-timeStandard Hours 40Shift

Day JobPosted Shift Description 8am-4:30pm (flexible), Remote Position

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