Pre-Authorization Spec - Must have direct insurance portal experience
概述预期授权专家负责通过保险/付款人和流程确定先前的授权要求，并完成计划和增加服务的先前授权。决定是否提供覆盖福利，并在 Epic 中记录预期授權信息。与订购供应商办公室沟通如果服务被批准或拒绝减少否认，并在需要时促进同行评审。责任 ·分析基于多种保险/支付人的要求完成预期授予所需的信息；确保覆盖/保险正确。·熟练利用第三方付款人/保险门户处理提交前审批；对保险提供商，他们的门户和授权批准期望有详细的了解。· 文件预审批结果完全完整，并向领导层，供应商和/或护士进行通知，先审批或拒绝。通过以时间敏感的方式处理预审稿方式为患者/服务商辩护，并与医生和护士合作获得申请所需的临床信息。·确定挑战，趋势和模式，并与管理人员合作解决和解决问题。· 其他任务如指定的。确定保险/付款人和流程的先前授权要求，并完成预期服务的先前许可以及添加服务。· 确定服务是否属于受惠福利，并在 Epic 中记录预审批信息。· 与订购提供商办公室沟通·如果服务被批准或拒绝以减少否认，并在必要时促进同行评价。资格：高中文凭或 GED 工作经验：必需英语技能基本阅读能力基础书写技巧基本口头技能的语言技能 沟通技能 对客户/同事进行适当响应的能力 与各种各样的人互动保持机密信息 仅能向受理传达真相或拒绝披露信息的能力 能够投影专业，友好和有用的行为计算机技能 基本计算机知识：使用文字处理，表格表，电子邮件应用程序和网页浏览器。与 Windows OS 舒适并学习新应用程序。卡尔健康公司在这里概述它。找到工作，职业生涯，你是为了什么目的。在卡尔健康，我们致力于促进每个团队成员感到有价值的地方的工作场所，r
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Overview
The Pre-Authorization Specialist is responsible for identifying prior auth requirements by insurance/payer and processes and completes prior authorizations for scheduled and add on services. Determines if services are a covered benefit and documents pre-authorization information in Epic. Communicates with the ordering Provider's office if services were approved or denied to reduce denials and facilitates peer to peer reviews when needed.Responsibilities
- Analyzes information required to complete pre-authorizations based on multiple insurance/payer requirements; ensures coverage/insurance is correct.
- Proficiently utilizes third party payer/insurance portals to process pre-auth submissions; has a detailed knowledge of insurance providers, their portals and expectations for authorization approval.
- Documents pre-authorization results completely and communicates to leadership, Providers and/or Nurses pre-authorization approvals or denials. Advocates for patients/providers by processing pre-auths in a time sensitive manner and collaborating with physicians and nurses to secure clinical information needed for submissions.
- Identifies challenges, trends and patterns and works with management to address and resolve.
- Other duties as assigned. Identifying prior auth requirements by insurance/payer and processes and completes prior authorizations for scheduled and add on services.
- Determines if services are a covered benefit and documents pre-authorization information in Epic.
- Communicates with the ordering Provider office
- if services were approved or denied to reduce denials and facilitates peer to peer reviews when needed.
Qualifications
Education: Highschool Diploma or GED
Work Experience:
Required English Skills Basic reading skillsBasic writing skillsBasic oral skills
Communication Skills Ability to respond appropriately to customer/co-workerInteraction with a wide variety of peopleMaintain confidential informationAbility to communicate only the facts to recipients or to decline to reveal informationAbility to project a professional, friendly, helpful demeanor
Computer Skills Basic computer knowledge: Uses word processing, spreadsheet, e-mail application, and web browser. Comfortable with Windows OS and learning new applications.
Carle Health Company Overview
Find it here.
Discover the job, the career, the purpose you were meant for. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. Find it all at Carle Health.
Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois. We’ve grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. We’re developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Methodist College. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: .
Salary Range
The compensation range for this position is $18per hour - $29.13per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate’s experience, qualifications, location, training, licenses, shifts worked and compensation model. Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit careers.carlehealth.org/benefits.Originally posted on Himalayas