Community Memorial Health System
Authorization and Pre-Registration Specialist - On Site
Community Memorial Health System, Hamilton, New York, United States, 13346
Responsibilities and Duties:
Insurance Verification & Eligibility
Verify patient insurance coverage and benefits before inpatient admissions or outpatient procedures. Confirm details such as policy status, copays, deductibles, and service coverage. Contact patients ahead of scheduled services to verify demographics and insurance information Authorization Requests
Check and verify outpatient Authorizations and submit prior authorization requests for inpatient insurance payers (Medicare, Medicaid, HMO, PPO). Ensure that all required data elements (CPT codes, diagnosis codes, clinical documentation) are included. Handle both elective and urgent/emergent inpatient admissions and outpatient surgical/day care procedures. Follow-Up & Case Management
Track pending authorizations and follow up with insurers to secure timely approvals. Escalate cases with potential financial clearance risks to management. Maintain accurate records of authorization status for each patient encounter. Communication & Coordination
Act as a liaison between patients, providers, and insurance companies. Answer incoming calls related to pre-authorization support and provide case handling. Coordinate with scheduling staff to ensure services are not performed without proper authorization. Compliance & Documentation
Ensure compliance with payer requirements and hospital/clinic financial clearance programs. Document all authorization activities in patient records and billing systems. Maintain tracking system and follow up on pending authorizations Support revenue cycle integrity by preventing claim denials due to missing authorizations. Verifies physician order for testing and contacts patient to preregister Performs other duties as assigned Qualifications :
Education & Experience:
1-2 + Years in a Healthcare environment Basic understanding of insurance authorization process Experience in Patient Access or Billing Strong Insurance knowledge Basic understanding of medical terminology Skills & Competencies:
Use of various insurance portals Knowledge of each individual insurance company’s rules and regulations Works as a vital team member with good time management skills and tasking important items Work independently requiring a minimum of detailed supervision and guidance Responsible for maintaining own individual case load
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
Insurance Verification & Eligibility
Verify patient insurance coverage and benefits before inpatient admissions or outpatient procedures. Confirm details such as policy status, copays, deductibles, and service coverage. Contact patients ahead of scheduled services to verify demographics and insurance information Authorization Requests
Check and verify outpatient Authorizations and submit prior authorization requests for inpatient insurance payers (Medicare, Medicaid, HMO, PPO). Ensure that all required data elements (CPT codes, diagnosis codes, clinical documentation) are included. Handle both elective and urgent/emergent inpatient admissions and outpatient surgical/day care procedures. Follow-Up & Case Management
Track pending authorizations and follow up with insurers to secure timely approvals. Escalate cases with potential financial clearance risks to management. Maintain accurate records of authorization status for each patient encounter. Communication & Coordination
Act as a liaison between patients, providers, and insurance companies. Answer incoming calls related to pre-authorization support and provide case handling. Coordinate with scheduling staff to ensure services are not performed without proper authorization. Compliance & Documentation
Ensure compliance with payer requirements and hospital/clinic financial clearance programs. Document all authorization activities in patient records and billing systems. Maintain tracking system and follow up on pending authorizations Support revenue cycle integrity by preventing claim denials due to missing authorizations. Verifies physician order for testing and contacts patient to preregister Performs other duties as assigned Qualifications :
Education & Experience:
1-2 + Years in a Healthcare environment Basic understanding of insurance authorization process Experience in Patient Access or Billing Strong Insurance knowledge Basic understanding of medical terminology Skills & Competencies:
Use of various insurance portals Knowledge of each individual insurance company’s rules and regulations Works as a vital team member with good time management skills and tasking important items Work independently requiring a minimum of detailed supervision and guidance Responsible for maintaining own individual case load
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.