Preauthorization Specialist
Overview
The Preauthorization Specialist obtains insurance eligibility, benefits, authorizations, pre-certifications and referrals for inpatient and outpatient, scheduled and non-scheduled 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 customer-focused and compassionate manner to ensure patients and their representatives needs are met. Hours: Monday-Friday 8am-4:30pm Location: Remote - applicants preferably reside in the UPH geography of Iowa, Illinois, or Wisconsin Why UnityPoint Health? At UnityPoint Health, you matter. We’re proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's 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 you’re 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 long-term disability and more. We even offer pet insurance for your four-legged 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 ICD-10 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 pre-certification process with physicians, PHO sites or insurance companies and obtains pre-cert/authorization numbers and adds them to the electronic health record and other pertinent information that secures reimbursement of account.
- Perform follow-up calls as needed until verification/pre-certification 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 pre-authorizations 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
- Previous customer service experience
- Experience interacting with patients and a working knowledge of third party payers
- Prior experience with verification, and payer benefit and eligibility systems is preferred
- Knowledge of Medical Terminology is preferred
- Knowledge of benefits and language is preferred
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