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Emory Healthcare/Emory University Payor Authorization Specialist, Utilization Review in Atlanta, Georgia

Overview

At Emory Healthcare, we integrate science and caring to change the face of health care. Our team members are courageous individuals who are willing to challenge the status quo and help find solutions to complex problems. We’re empowered to influence change for, and with, our patients, their families, the community and each other.

As one of the leading academic medical systems, we’re eager to share what we learn with hospitals around the country, and the world. We’ve got the backing, knowledge, experience and permission to lead the way in developing new and better approaches to preventing and treating disease, and our patients get treatments years before anyone else.

We’re defining a new standard of care for humankind. Are YOU ready to join us?

Description

JOB DESCRIPTION:

  • 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.MINIMUM REQUIREMENTS:

  • 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.

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Connect with us for general consideration!

Division Emory Univ Hospital

Campus Location Atlanta, GA, 30322

Campus Location US-GA-Atlanta

Department EUH Utilization Review

Job Type Regular Full-Time

Job Number 82028

Job Category Revenue Cycle & Managed Care

Schedule 8a-4:30p

Standard Hours 40 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.

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