The Christ Hospital Health Network
Authorization and Cost Estimate Analyst Lead
The Christ Hospital Health Network, Cincinnati, Ohio, United States, 45208
Authorization and Cost Estimate Analyst Lead - CBO Financial Clearance - Full Time - Days
Join to apply for the
Authorization and Cost Estimate Analyst Lead - CBO Financial Clearance - Full Time - Days
role at
The Christ Hospital Health Network
The Insurance Authorization & Cost Estimate Specialist Lead is responsible for facilitating the concerted efforts of the team to achieve and sustain desirable levels of customer service, accuracy of patient information for authorizations, estimates and patient assistance efficiently. This individual works in an integrated, harmonious manner with other team leads, departments and managers. The Lead serves as a mentor and role model for fellow team members through demonstrating an outstanding work ethic, superior technical knowledge, and concern for the values and mission. Maintains access to resources and ensures that accounts are complete and secure. This role will lead the team to collect necessary insurance benefit and clinical information to properly authorize the ordered service with the patient’s insurance company. This includes steps to support insurance and benefit verification, pre-certification, and pre-authorization processes. The Lead Specialist must have clinical knowledge of services so appropriate information can be communicated to the insurance company which will ensure the service is rendered in the correct level of care. Reimbursement for the service rendered is dependent upon the insurance benefit verification process and meeting the authorization requirements of the insurance company. This role must also determine when the patient is under-insured so that additional funding sources can be evaluated and applied. Once authorized, the lead specialist determines the cost for the service by applying the patient benefits / coverage information and estimate functionality accessible through IT applications. This process is essential to ensuring the patient understands their financial responsibilities for the service rendered. This is a very dynamic environment as insurance plans, benefits, and coverage structures change frequently and the turnaround is essential so that treatment is not delayed. This individual will need expert knowledge of insurance plans, insurance regulations, and insurance benefit and coverages as they relate to the service rendered. Additionally, this team serves as a point of contact within the organization for questions and issues as they relate to insurance plans and coverage information. The duties and responsibilities this individual performs are solely dependent on the organization receiving reimbursement for the service rendered and ensuring the patients cost are clearly identified.
Responsibilities
Lead Duties
Works complex problem accounts, serves as point of contact for addressing account issues, patient concerns, or billing and insurance questions
Oversees the Insurance Verification/Pricing Transparency/FC team members responsibilities and duties
Develops team members through group and one-on-one training and in-services
Implements, monitors, and appropriately reacts to quality assurance mechanisms
Develops and revises insurance verification/estimation and financial counseling procedures, coordinating with other revenue cycle and clinical teams to ensure overall revenue cycle efficiency
Facilitates, implements, and monitors qualitative and quantitative work performance expectations
Serves as point of contact for addressing account issues, patient concerns, or billing and insurance questions
Resolves operating issues
Co-develops, communicates, and tracks progress towards meaningful goals
Prepares staffing schedules, posts vacations, etc
Insurance Verification
Utilizes online systems, phone communication, and other resources to verify eligibility and benefits, determine extent of coverage, secure pre-authorizations, and determine patient liabilities within a timeframe before scheduled appointments determined by The Christ Hospital Health Network and during or after care for unscheduled patients
Verifies medical necessity in accordance with CMS standards, and communicates relevant coverage/eligibility information to the patient
Communicates with patients, physicians, clinicians, front-end staff, or translators to obtain missing patient demographic or insurance information
Coordinates benefits by effectively determining primary, secondary, and tertiary liability when needed
Obtains pre-certifications and pre-authorizations from third-party payers in accordance with payer requirements
Provides collections team with personalized patient estimates of financial responsibility based on insurance coverage or eligibility for government programs
Remains updated on rates and changes to pricing/estimation system as necessary to ensure price estimates remain accurate
Alerts physician offices to issues with verifying insurance and/or obtaining pre-authorizations
Demonstrates understanding of insurance terminology and analyzes information to determine patients’ out-of-pocket liabilities
Communicates liabilities directly to patients and provides education on key insurance terms and rules; may handle patients with more complicated insurance plans
Connects patients with financial counselors when further explanation or education is needed regarding payment plans or financial assistance; may conduct some basic financial counseling duties
Estimates
Provides collections team with personalized patient estimates of financial responsibility based on insurance coverage or eligibility for government programs
Communicates liabilities directly to patients and provides education on key insurance terms and rules; may handle patients with more complicated insurance plans
Financial Counseling
Oversees the Financial Counselors’ responsibilities including acting as the patient advocate to secure some form of sponsorship for non-insured, medically necessary services
Must have knowledge of application processes for government programs
Qualifications
EDUCATION: High School Diploma or GED with minimum 3 years customer service experience in a hospital or physician office setting; Medical insurance knowledge 1 year. Bachelor’s Degree in Healthcare Admin or related field, Government Program experience 1 year preferred
YEARS OF EXPERIENCE: 1–2 years of registration or insurance verification related experience required. 2 years registration/billing/insurance experience required
Three Years Of Registration Experience Preferred
REQUIRED SKILLS AND KNOWLEDGE: Strong Analytical Skills; Customer Service Experience Required
Knowledge of EHR programs (e.g., Epic), medical terminology, ICD-10, CPT, HCPCS codes, and coding processes
Understanding of revenue cycle, superb teamwork, time management, communication skills
Epic experience, 35 wpm data entry, strong verbal communication
Licenses/Registrations & Certifications: Annual Registration Competency Test at 95%, Stat Test
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Finance and Sales
Industries: Hospitals and Health Care
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Authorization and Cost Estimate Analyst Lead - CBO Financial Clearance - Full Time - Days
role at
The Christ Hospital Health Network
The Insurance Authorization & Cost Estimate Specialist Lead is responsible for facilitating the concerted efforts of the team to achieve and sustain desirable levels of customer service, accuracy of patient information for authorizations, estimates and patient assistance efficiently. This individual works in an integrated, harmonious manner with other team leads, departments and managers. The Lead serves as a mentor and role model for fellow team members through demonstrating an outstanding work ethic, superior technical knowledge, and concern for the values and mission. Maintains access to resources and ensures that accounts are complete and secure. This role will lead the team to collect necessary insurance benefit and clinical information to properly authorize the ordered service with the patient’s insurance company. This includes steps to support insurance and benefit verification, pre-certification, and pre-authorization processes. The Lead Specialist must have clinical knowledge of services so appropriate information can be communicated to the insurance company which will ensure the service is rendered in the correct level of care. Reimbursement for the service rendered is dependent upon the insurance benefit verification process and meeting the authorization requirements of the insurance company. This role must also determine when the patient is under-insured so that additional funding sources can be evaluated and applied. Once authorized, the lead specialist determines the cost for the service by applying the patient benefits / coverage information and estimate functionality accessible through IT applications. This process is essential to ensuring the patient understands their financial responsibilities for the service rendered. This is a very dynamic environment as insurance plans, benefits, and coverage structures change frequently and the turnaround is essential so that treatment is not delayed. This individual will need expert knowledge of insurance plans, insurance regulations, and insurance benefit and coverages as they relate to the service rendered. Additionally, this team serves as a point of contact within the organization for questions and issues as they relate to insurance plans and coverage information. The duties and responsibilities this individual performs are solely dependent on the organization receiving reimbursement for the service rendered and ensuring the patients cost are clearly identified.
Responsibilities
Lead Duties
Works complex problem accounts, serves as point of contact for addressing account issues, patient concerns, or billing and insurance questions
Oversees the Insurance Verification/Pricing Transparency/FC team members responsibilities and duties
Develops team members through group and one-on-one training and in-services
Implements, monitors, and appropriately reacts to quality assurance mechanisms
Develops and revises insurance verification/estimation and financial counseling procedures, coordinating with other revenue cycle and clinical teams to ensure overall revenue cycle efficiency
Facilitates, implements, and monitors qualitative and quantitative work performance expectations
Serves as point of contact for addressing account issues, patient concerns, or billing and insurance questions
Resolves operating issues
Co-develops, communicates, and tracks progress towards meaningful goals
Prepares staffing schedules, posts vacations, etc
Insurance Verification
Utilizes online systems, phone communication, and other resources to verify eligibility and benefits, determine extent of coverage, secure pre-authorizations, and determine patient liabilities within a timeframe before scheduled appointments determined by The Christ Hospital Health Network and during or after care for unscheduled patients
Verifies medical necessity in accordance with CMS standards, and communicates relevant coverage/eligibility information to the patient
Communicates with patients, physicians, clinicians, front-end staff, or translators to obtain missing patient demographic or insurance information
Coordinates benefits by effectively determining primary, secondary, and tertiary liability when needed
Obtains pre-certifications and pre-authorizations from third-party payers in accordance with payer requirements
Provides collections team with personalized patient estimates of financial responsibility based on insurance coverage or eligibility for government programs
Remains updated on rates and changes to pricing/estimation system as necessary to ensure price estimates remain accurate
Alerts physician offices to issues with verifying insurance and/or obtaining pre-authorizations
Demonstrates understanding of insurance terminology and analyzes information to determine patients’ out-of-pocket liabilities
Communicates liabilities directly to patients and provides education on key insurance terms and rules; may handle patients with more complicated insurance plans
Connects patients with financial counselors when further explanation or education is needed regarding payment plans or financial assistance; may conduct some basic financial counseling duties
Estimates
Provides collections team with personalized patient estimates of financial responsibility based on insurance coverage or eligibility for government programs
Communicates liabilities directly to patients and provides education on key insurance terms and rules; may handle patients with more complicated insurance plans
Financial Counseling
Oversees the Financial Counselors’ responsibilities including acting as the patient advocate to secure some form of sponsorship for non-insured, medically necessary services
Must have knowledge of application processes for government programs
Qualifications
EDUCATION: High School Diploma or GED with minimum 3 years customer service experience in a hospital or physician office setting; Medical insurance knowledge 1 year. Bachelor’s Degree in Healthcare Admin or related field, Government Program experience 1 year preferred
YEARS OF EXPERIENCE: 1–2 years of registration or insurance verification related experience required. 2 years registration/billing/insurance experience required
Three Years Of Registration Experience Preferred
REQUIRED SKILLS AND KNOWLEDGE: Strong Analytical Skills; Customer Service Experience Required
Knowledge of EHR programs (e.g., Epic), medical terminology, ICD-10, CPT, HCPCS codes, and coding processes
Understanding of revenue cycle, superb teamwork, time management, communication skills
Epic experience, 35 wpm data entry, strong verbal communication
Licenses/Registrations & Certifications: Annual Registration Competency Test at 95%, Stat Test
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Finance and Sales
Industries: Hospitals and Health Care
Referrals increase your chances of interviewing at The Christ Hospital Health Network by 2x
Get notified about new Cost Analyst jobs in Cincinnati, OH.
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr