Highland Hospital of Rochester NY
Health Insurance & Authorization Specialist I
Highland Hospital of Rochester NY, Rochester, New York, United States
Health Insurance & Authorization Specialist I
Location: Rochester, NY | Employment Status: Full-Time | Hours per week: 40 | Seniority level: Mid-Senior level | Employment type: Full-time
Job Summary The Health Insurance and Authorization Specialist is responsible for assessing and performing quality control functions for all preadmission visits on surgical inpatient, short stay 23 (SS23), Endo and ambulatory procedures, ensuring that all pertinent information is on file and accurately documented. These activities include reviewing diagnosis and history for correct insurance coverage, verifying insurance eligibility and coverage using the three patient identifiers, confirming prior authorization is on file for correct level of care, inquiring on prior authorization denials and working with the provider’s office to resolve them, requesting estimated cost and collecting deposits for non-covered services, ensuring appropriate medical justification is documented for out-of-network payers, referring our self-pay patients to Financial Case Management (FCM) for Medicaid assessment or Financial Assistance, reviewing and validating MSP questions, monitoring Medicare days for exhausted benefits, identifying and resolving coordination of benefits discrepancies, and notifying Utilization Management of additional clinical requests.
Salary Range $19.62 - $26.49 an hour
The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job’s compensation range, and will be determined by considering factors including but not limited to market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.
Job Requirements
Education: High school diploma or equivalent required. Associate degree preferred in related discipline (admitting, registration, patient billing, insurance); or equivalent experience.
Experience: Minimum of 3 years of related experience, preferably in a hospital setting, medical office billing, and/or knowledge of third-party insurance regulations.
Skills: Requires a high degree of professionalism and motivation with excellent communication and customer service skills, and medical terminology. Good interpersonal and telephone skills. Detail-oriented. Computer, copier, and fax skills.
Req ID: None
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Job Summary The Health Insurance and Authorization Specialist is responsible for assessing and performing quality control functions for all preadmission visits on surgical inpatient, short stay 23 (SS23), Endo and ambulatory procedures, ensuring that all pertinent information is on file and accurately documented. These activities include reviewing diagnosis and history for correct insurance coverage, verifying insurance eligibility and coverage using the three patient identifiers, confirming prior authorization is on file for correct level of care, inquiring on prior authorization denials and working with the provider’s office to resolve them, requesting estimated cost and collecting deposits for non-covered services, ensuring appropriate medical justification is documented for out-of-network payers, referring our self-pay patients to Financial Case Management (FCM) for Medicaid assessment or Financial Assistance, reviewing and validating MSP questions, monitoring Medicare days for exhausted benefits, identifying and resolving coordination of benefits discrepancies, and notifying Utilization Management of additional clinical requests.
Salary Range $19.62 - $26.49 an hour
The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job’s compensation range, and will be determined by considering factors including but not limited to market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.
Job Requirements
Education: High school diploma or equivalent required. Associate degree preferred in related discipline (admitting, registration, patient billing, insurance); or equivalent experience.
Experience: Minimum of 3 years of related experience, preferably in a hospital setting, medical office billing, and/or knowledge of third-party insurance regulations.
Skills: Requires a high degree of professionalism and motivation with excellent communication and customer service skills, and medical terminology. Good interpersonal and telephone skills. Detail-oriented. Computer, copier, and fax skills.
Req ID: None
#J-18808-Ljbffr