Emory Healthcare/Emory University Payor Authorization Specialist-Emory Temporary Services in Atlanta, Georgia
Emory University is a leading research university that fosters excellence and attracts world-class talent to innovate today and prepare leaders for the future.We welcome candidates who can contribute to the diversity and excellence of our academic community.
Initiates verification of eligibility and of plan benefits; notifies and authorizes all inpatient and observation accounts.
Follows developed policies and procedures to obtain insurance benefits.
Contacts third party payers for insurance benefits to verify eligibility and initiates preauthorization for services.
Identifies correct insurance plan, financial class, and coordination of benefits.
Calculates deductibles and co-payments due.
Processes out-of-network requests and notify the Case Manager immediately.
Refers private pay accounts to the financial counselor.
Maintains database integrity by accurately identifying correct account to secure and enters complete and accurate patient information.
Responsible for obtaining clinical authorization by communicating patient and clinical information, medical necessity, and level of care to payers to secure account for reimbursement.
Applies to urgent direct and unscheduled admissions, in addition to continued stay and scheduled admissions when payers require current clinical information beyond initial days authorized.
Receives patient information from the team of Care Managers and Financial Counselors to secure identified patient accounts within 24 hours of admission or the following business day according to payer requirements.
Enters authorization documentation into Midas and IDX.
Prioritizes work for optimal reimbursement and to avoid financial risk to both patient and hospital.
Understands role within the Revenue Cycle.
Extensive use of keyboarding, multi-tasking skills and use of office equipment expected.
High school education diploma or equivalent.
Associate's or Bachelor's Degree preferred.
Licensed Practical Nurse (LPN) preferred.
CPAR or CHAA certification desired or willing to obtain during first year of employment.
A minimum of three (3) to five (5) years experience in a clinical and/or managed care setting.
Two (2) years minimum of health insurance plans and health insurance verification preferred.
Emory University is dedicated to providing equal opportunities and equal access to all individuals regardless of race, color, religion, ethnic or national origin, gender, genetic information, age, disability, sexual orientation, gender identity, gender expression, and veteran's status. Emory University does not discriminate in admissions, educational programs, or employment on the basis of any factor stated above or prohibited under applicable law. Students, faculty, and staff are assured of participation in University programs and in the use of facilities without such discrimination. Emory University complies with Executive Order 11246, as amended, Section 503 of the Rehabilitation Act of 1973, the Vietnam Era Veteran's Readjustment Assistance Act, and applicable executive orders, federal and state regulations regarding nondiscrimination, equal opportunity and affirmative action. Emory University is committed to achieving a diverse workforce through application of its affirmative action, equal opportunity and nondiscrimination policy in all aspects of employment including recruitment, hiring, promotions, transfers, discipline, terminations, wage and salary administration, benefits, and training. Inquiries regarding this policy should be directed to the Emory University Department of Equity and Inclusion, 201 Dowman Drive, Administration Building, Atlanta, GA 30322. Telephone: 404-727-9867 (V) | 404-712-2049 (TDD).
Emory University is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. To request this document in an alternate format or to request a reasonable accommodation, please contact the Department of Accessibility Services at 404-727-9877 (V) | 404-712-2049 (TDD). Please note that one week advance notice is preferred.
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Division Emory Univ Hosp-Midtown
Campus Location Atlanta, GA, 30308
Campus Location US-GA-Atlanta
Department EHM Utilization Review
Job Type Temporary Part-Time
Job Number 69261
Job Category Clerical & Administrative
Standard Hours 30 Hours
Emory Healthcare is an Equal Employment Opportunity employer committed to providing equal opportunity in all of its employment practices and decisions. Emory Healthcare prohibits discrimination, harassment, and retaliation in employment based on race, color, religion, national origin, sex, sexual orientation, gender identity or expression, pregnancy, age (40 and over), disability, citizenship, genetic information, service in the uniformed services, veteran status or any other classification protected by applicable federal, state, or local law.
Emory Healthcare/Emory University
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