Preauthorization Specialist
Preauthorization Specialist
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Job Description
Overview
Preauthorization Specialist
Dubuque IA
MondayFriday 8:00AM5:00PM
Full Time Benefits
Obtains insurance eligibility benefits authorizations precertifications and referrals for inpatient and outpatient scheduled and nonscheduled visits. Updates demographic and insurance information in system as needed. Primary documentation source for access and billing staff. Resolve accounts on work queues. Work with insurance companies to appeal denials. Interacts in a customerfocused and compassionate manner to ensure patients and their representatives needs are met.
Why UnityPoint Health
At UnityPoint Health you matter. Were proud to be recognized as a Top 150 Place to Work in Healthcare by Beckers Healthcare several years in a row for our commitment to our team members.
Our competitive Total Rewards program offers benefits options that align with your needs and priorities no matter what life stage youre in. Here are just a few:
- Expect paid time off parental leave 401K matching and an employee recognition program.
- Dental and health insurance paid holidays short and longterm disability and more. We even offer pet insurance for your fourlegged family members.
- Early access to earned wages with Daily Pay tuition reimbursement to help further your career and adoption assistance to help you grow your family.
With a collective goal to champion a culture of belonging where everyone feels valued and respected we honor the ways people are unique and embrace what brings us together.
And we believe equipping you with support and development opportunities is a vital part of delivering an exceptional employment experience.
Find a fulfilling career and make a difference with UnityPoint Health.
Responsibilities
Insurance Verification/Certification
Obtains daily work from multiple work queues to identify what is required by CBO.
Work with providers to assure that CPT and ICD10 code is correct for procedure ordered and is authorized when necessary.
Completes eligibility check and obtain benefits though electronic means or via phone contact with insurance carriers or other agencies and when necessary/requested provide initial clinical documentation.
Initiates precertification process with physicians PHO sites or insurance companies and obtains precert/authorization numbers and adds them to the electronic health record and other pertinent information that secures reimbursement of account.
Perform followup calls as needed until verification/precertification process is complete
Thoroughly documents information and actions in all appropriate computer systems
Notify and inform Utilization Review staff of authorization information to insure timely concurrent review
Validates or update insurance codes and priority for billing accuracy.
Works with insurance companies to obtain retroactive authorization when not obtained at time of service.
Works with insurance companies providers coders and case management to appeal denied claims.
Responsible for following EMTALA HIPAA payer and other regulations and standards.
Responsible for meeting daily productivity and quality standards associated with job requirements.
Customer Services
Adheres to department customer service standards.
Perform research to resolve customer problems
Collaborate with other departments to assist in obtaining preauthorizations in a cross functional manner
Develop and implement prior authorization workflow to meet the needs of the customers.
Readily identifies work that needs to be performed and completes it without needing to be told.
Coordinates work to achieve maximum productivity and efficiencies
Monitors and responds timely to all inquiries and communications.
Qualifications
Education
Requires minimally a High school diploma or GED.
Experience
Previous customer service experience.
Experience interacting with patients and a working knowledge of third party payers.
License(s)/Certification(s)
Valid drivers license when driving any vehicle for workrelated reasons.
Knowledge/Skills/Abilities
Ability to perform a variety of tasks often changing assignments on short notice.
Must be adept at multitasking
Will be required to learn and work with multiple software/hardware products (sometimes concurrently) during the course of an average work day
Must possess excellent communication skills verbal and listening.
Must be able to maintain a professional demeanor in stressful situations.
Adept with machinery typically found in a business office environment.
Mathematical aptitude to make contractual calculations and estimate patient financial obligations.
Able to build productive relationships with all contacts.
Must be able to perform data entry with speed and accuracy
Required Experience:
Unclear Seniority
Employment Type
Full-Time
