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