Rochester Regional Health
Finance and Authorization Specialist
Rochester Regional Health, Rochester, New York, United States
Summary
The primary responsibility of the Finance and Authorization Specialist is to promptly verify patient’s insurance, obtain and verify it if not provided, provide accurate patient estimates as requested, obtain or verify authorization for the procedures and treatments ordered by the department and ordering providers, and maintain communication with multiple departments regarding findings and issues.
Position Details
Status:
Full Time
Location:
SCHI- Linden Oaks, 30 Hagen Drive, Rochester, NY 14625
Department:
Billing
Schedule:
Monday–Friday, 7:30 a.m.–4 p.m. with some flexibility
Attributes
Previous experience with insurance verification and benefit application, familiarity with ICD-10 diagnosis and procedure codes, and CPT/HCPCS codes.
Proficiency with a variety of computer and spreadsheet applications and common office equipment.
Flexibility and ability to work as a team player.
Ability to handle simultaneous tasks with great attention to detail.
Excellent communication skills, including oral, written, and interpersonal.
Excellent problem‑solving and follow‑through skills.
Experience using EMR software.
Additional basic computer skills required.
Excellent customer‑service and communication skills required.
Responsibilities
Utilize appropriate insurance verification tools to validate patient insurance eligibility.
Generate timely patient estimates through the use of Rochester Regional Health's Estimate Tool.
Support internal offices with generating estimates for future services, as requested.
Deliver price estimates to patients in a courteous and knowledgeable manner.
Deliver finalized estimate findings to patients via phone, email, or MyCare channels.
Obtain prior authorization on both internal and external department orders for procedures/treatments performed in the department; applicable to both new and established patients.
Coordinate with Patient Registration to appropriately and accurately schedule patients in accordance with the provider’s orders.
Communicate with other departments to address scheduling or authorization issues.
Complete forms and letters to insurance for visit coverage.
Monitor daily schedules for add‑on appointments, insurance changes, and work accordingly within our policies to verify insurance, process estimates, and/or obtain authorizations.
Monitor pending authorizations and follow due process should it need to be rescheduled.
Participate in orientation of new staff.
Obtain referrals from payers that require it.
Obtain insurance information through various searches when not in the system.
Complete other duties as assigned.
Oncology Specific Responsibilities
Obtain prior authorization on internal department orders for medications administered at oncology infusion locations; applicable to both new and established patients.
Review oncology infusion orders for medical necessity per CMS, manufacturer, or NCCN guidelines. Work with physicians if these specific guidelines are not met by documentation.
Verify authorizations for non‑oncology patients for whom we have received medication administration orders.
Communicate to oncology pharmacy the insurer preferred brands for requested products.
Assist with research and resolution of denials as requested.
Minimum Qualifications
2 years related work experience in a healthcare or insurance setting.
Required Licensure/Certification None
Physical Requirements SEDENTARY: Work requires walking or standing only occasionally; limits include exerting up to 10 pounds of force.
Pay Range $18.00 – $25.00
Equal Opportunity Employer Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.
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Position Details
Status:
Full Time
Location:
SCHI- Linden Oaks, 30 Hagen Drive, Rochester, NY 14625
Department:
Billing
Schedule:
Monday–Friday, 7:30 a.m.–4 p.m. with some flexibility
Attributes
Previous experience with insurance verification and benefit application, familiarity with ICD-10 diagnosis and procedure codes, and CPT/HCPCS codes.
Proficiency with a variety of computer and spreadsheet applications and common office equipment.
Flexibility and ability to work as a team player.
Ability to handle simultaneous tasks with great attention to detail.
Excellent communication skills, including oral, written, and interpersonal.
Excellent problem‑solving and follow‑through skills.
Experience using EMR software.
Additional basic computer skills required.
Excellent customer‑service and communication skills required.
Responsibilities
Utilize appropriate insurance verification tools to validate patient insurance eligibility.
Generate timely patient estimates through the use of Rochester Regional Health's Estimate Tool.
Support internal offices with generating estimates for future services, as requested.
Deliver price estimates to patients in a courteous and knowledgeable manner.
Deliver finalized estimate findings to patients via phone, email, or MyCare channels.
Obtain prior authorization on both internal and external department orders for procedures/treatments performed in the department; applicable to both new and established patients.
Coordinate with Patient Registration to appropriately and accurately schedule patients in accordance with the provider’s orders.
Communicate with other departments to address scheduling or authorization issues.
Complete forms and letters to insurance for visit coverage.
Monitor daily schedules for add‑on appointments, insurance changes, and work accordingly within our policies to verify insurance, process estimates, and/or obtain authorizations.
Monitor pending authorizations and follow due process should it need to be rescheduled.
Participate in orientation of new staff.
Obtain referrals from payers that require it.
Obtain insurance information through various searches when not in the system.
Complete other duties as assigned.
Oncology Specific Responsibilities
Obtain prior authorization on internal department orders for medications administered at oncology infusion locations; applicable to both new and established patients.
Review oncology infusion orders for medical necessity per CMS, manufacturer, or NCCN guidelines. Work with physicians if these specific guidelines are not met by documentation.
Verify authorizations for non‑oncology patients for whom we have received medication administration orders.
Communicate to oncology pharmacy the insurer preferred brands for requested products.
Assist with research and resolution of denials as requested.
Minimum Qualifications
2 years related work experience in a healthcare or insurance setting.
Required Licensure/Certification None
Physical Requirements SEDENTARY: Work requires walking or standing only occasionally; limits include exerting up to 10 pounds of force.
Pay Range $18.00 – $25.00
Equal Opportunity Employer Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.
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