Authorization and Insurance Coordinator I-Days

General Summary

Performs a variety of support functions for each assigned facility including, but not limited to, monitoring imaging and infusion schedules to ensure authorizations have been obtained and answering calls regarding referrals and authorizations; or, insurance verification, obtaining authorizations, mailing patient responsibility letters, and receiving payments through the mail. Possesses a working knowledge of insurance requirements and restrictions.

Duties and Responsibilities

Essential Functions:

• AUTHORIZATION DUTIES: • Performs online and telephone authorization verification for outpatient imaging procedures and infusion procedures. • Contacts provider offices to obtain authorizations and referrals as needed. • Obtains authorizations for outpatient imaging procedures ordered by the facility providers as needed. • Maintains appropriate documentation in Eclipsys and on the authorization spreadsheets. • Notifies imaging sites of financial waivers or ABN’s that must be signed at least two hours prior to testing or infusion. • Contacts patients the evening prior to their procedure if authorization is not obtained to give them the option of rescheduling their study or signing a financial waiver. • Answers phone calls regarding authorizations or referrals. • Completes audit slips for registration errors.
• INSURANCE VERIFICATION DUTIES: • Performs online and telephone authorization verification for surgical patients, patients considering pulmonary rehabilitation, and patients undergoing other medical procedures. • Sends patient letters documenting co-pay and deductible information. • Obtains authorizations for outpatient surgeries and invasive outpatient procedures that do not use the PHAS process. • Maintains appropriate documentation in Eclipsys. • Receives patient co-pay and deductible payments in the mail. Documents the payments in Eclipsys and prepares the deposit of these funds. • Assists pre-registration staff with insurance questions as needed.

Common Expectations:

• Ensures patient confidentiality.
• Maintains established policies and procedures, objectives, quality assessment and safety standards.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation
• Establishes and maintains files and records on an ongoing basis.
• Opens and routes incoming mail; distributes correspondence and other material to staff.

Required for All Jobs:

• Performs other related duties as identified.
• WellSpan Health has adopted and implemented a compliance program to support WellSpan's values and standards for professionalism, integrity, and ethics. Expected to support and meet the values and standards of the organization and the performance expectations of the job, the department, and the compliance program.
• WellSpan Health has adopted and implemented a privacy program to safeguard the patient information and the business and operational information of the organization. Expected to support and meet the values and standards of the organization to safeguard patient and business/operational information.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

Physical Demands:

• Standing - Occasionally
• Walking - Occasionally
• Sitting - Frequently
• Reaching - Rarely
• Talking - Frequently
• Hearing - Frequently
• Repetitive Motions - Occasionally
• Eye/Hand/Foot Coordination - Occasionally

Benefits Offered:

• Comprehensive health benefits
• Retirement savings plan
• Paid time off (PTO)
• Education assistance
• Financial education and support, including DailyPay
• Expanded Paid Parental Leave

For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org)

Qualifications

Minimum Education:

• High School Diploma or GED Required

Work Experience:

• 1 year Medical insurance experience. Required

Courses and Training:

• Medical terminology. within 180 days Required