Hospital Authorization Specialist (Finance)
Full time, Monday through Friday 8:30-5, remote, must live with 1 hour of Nemours Wilmington
Essential Functions
- Ensure request for authorization is timely and handled in accordance with departmental policy and payer requirements.
- Accurately verify patient demographics, insurance eligibility, benefits, and financial responsibility.
- Ability of request and obtain preauthorization for assigned specialties and be able to cover for other specialties including workqueues, preadmissions, estimates, etc.
- Build and maintain professional, cooperative relationships with all departments that have direct or indirect impact on obtaining authorizations.
- Contact families in person or by phone contact to obtain necessary information and assist them with insurance issues and/or handle direct PA and DE Medicaid newborn enrollment.
- Prepare estimates for scheduled services. Must interpret patient's benefits correctly for accurate estimates.
- Clearly document all communications and contacts with payers, physicians, and families in standardized documentation requirements including proper format. Communicate effectively, timely and professionally in writing and verbally.
- Consistently demonstrates excellent, empathetic, and knowledgeable customer service skills to internal and external customers
- Collaborates with Financial Services for newborn enrollment, Medicaid enrollment/re-enrollment, self-pay referrals, estimates and Nemours funding.
- Follow all newly implemented workflows including those developed by Continuous Improvement projects. Participation in CI projects may be required as Supervisor/Manager determines.
Additional Requirements
- Authorization experience required.
- High School Diploma required. Specialized (1 year of training beyond high school)
- Minimum 6 months of experience required.
Nemours Children's Health offers a comprehensive and competitive benefit package which includes:
- Medical/Dental/Vision Insurance
- Tuition Reimbursement/Continuing Education Support
- 403(b) Retirement Plan
- Paid Time Off (PTO), VTO (Volunteer Time Off) and 6 paid holidays
- Professional/Clinical growth opportunities
- Work Life Benefits
