BH InsurancePrecert Specialist

Nationwide Children's Hospital

Job Location:

Columbus, NE - USA

Monthly Salary: USD 11 - 20

Posted on: 02-11-2025

Vacancies: 1 Vacancy

Job Summary

Overview:

Job Description Summary:

Verifies and documents benefit information. Requests initial authorization and meets providers referral requirements to ensure that optimum payment is made to the hospital and providers.

Job Description:

Essential Functions:

Contacts insurance companies to obtain and verify benefit information documents all benefit information and meets payers referral requirements to ensure that optimum payment to the hospital and providers will be satisfied.
Obtains insurance prior authorization as needed and documents the verification of benefits and prior authorizations in Epic. Maintains record of pending prior authorizations and documents timely follow-up.
Assists with the retrospective review of records for patients who have insurance changes that impact the authorization.
Communicates authorization denials and appeal options to referral sources/Providers. Assists with coverage resources as appropriate.
Contacts schedulers if insurance cannot be verified and refers self-pay patients to financial assistance resources.
Participates in department and interdepartmental meetings to promote knowledge troubleshoot and resolve issues related to benefits or authorizations.
Maintains knowledge of The Joint Commission Medicaid Medicare and other third-party payer standards and requirements.

Education Requirement:

High school graduate required.

Associates Degree preferred.

Licensure Requirement:

(not specified)

Certifications:

CPR certification (based on position and as determined by manager).

Skills:

Strong computer skills required with the ability to navigate most current technology systems.

Excellent written communication and organizational skills required.

Experience:

One year previous health care or insurance experience preferred.

Physical Requirements:

OCCASIONALLY: Bend/twist Biohazard waste Blood and/or Bodily Fluids Chemicals/Medications Communicable Diseases and/or Pathogens Driving motor vehicles (work required) *additional testing may be required Lifting / Carrying: 0-10 lbs Lifting / Carrying: 11-20 lbs Loud Noises Patient Equipment Pushing / Pulling: 0-25 lbs Reaching above shoulder Squat/kneel Standing Walking

FREQUENTLY: Flexing/extending of neck Hand use: grasping gripping turning

CONTINUOUSLY: Audible speech Color vision Computer skills Decision Making Depth perception Hearing acuity Interpreting Data Peripheral vision Problem solving Repetitive hand/arm use Seeing Far/near Sitting

Additional Physical Requirements performed but not listed above:

Able to multi-task within in a stressful environment.

The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified nor is it intended to limit or modify the right of any supervisor to assign direct and control the work of employees under their supervision. EOE M/F/Disability/Vet

Required Experience:

Overview:Job Description Summary:Verifies and documents benefit information. Requests initial authorization and meets providers referral requirements to ensure that optimum payment is made to the hospital and providers.Job Description:Essential Functions:Contacts insurance companies to obtain and ve...