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UnityPoint Health Pre-Authorization Specialist in Waterloo, Iowa

Position is remote/work from home within the UnityPoint Health regions.

Obtains insurance eligibility, benefits, authorizations, pre-certifications and referrals for inpatient and outpatient, scheduled and non-scheduled visits. Updates demographic and insurance information in system as needed. Primary documentation source for access and billing staff. Resolve accounts on work queues. Work with insurance companies to appeal denials. Interacts in a customer-focused and compassionate manner to ensure patients and their representatives needs are met.

Insurance Verification/Certification

  • Obtains daily work from multiple work queues to identify what is required by CBO.

  • Work with providers to assure that CPT and ICD-10 code is correct for procedure ordered and is authorized when necessary.

  • Completes eligibility check and obtain benefits though electronic means or via phone contact with insurance carriers or other agencies and when necessary/requested provide initial clinical documentation.

  • Initiates pre-certification process with physicians, PHO sites or insurance companies and obtains pre-cert/authorization numbers and adds them to the electronic health record and other pertinent information that secures reimbursement of account.

  • Perform follow-up calls as needed until verification/pre-certification process is complete

  • Thoroughly documents information and actions in all appropriate computer systems

  • Notify and inform Utilization Review staff of authorization information to insure timely concurrent review

  • Validates or update insurance codes and priority for billing accuracy.

  • Works with insurance companies to obtain retroactive authorization when not obtained at time of service.

  • Works with insurance companies, providers, coders and case management to appeal denied claims.

  • Responsible for following EMTALA, HIPAA, payer and other regulations and standards.

  • Responsible for meeting daily productivity and quality standards associated with job requirements.

Customer Services

  • Adheres to department customer service standards.

  • Perform research to resolve customer problems

  • Collaborate with other departments to assist in obtaining pre-authorizations in a cross functional manner

  • Develop and implement prior authorization workflow to meet the needs of the customers.

  • Readily identifies work that needs to be performed and completes it without needing to be told.

  • Coordinates work to achieve maximum productivity and efficiencies

  • Monitors and responds timely to all inquiries and communications.

Education:

  • Requires minimally a High school diploma or GED.

  • Two years of experience in a hospital patient access/patient accounts department, medical office/clinic or insurance company is desired/preferred.

Experience:

  • Previous customer service experience.

  • Experience interacting with patients and a working knowledge of third party payers.

  • Prior experience with verification, and payer benefit and eligibility systems is preferred.

Knowledge/Skills/Abilities:

  • Ability to perform a variety of tasks, often changing assignments on short notice.

  • Must be adept at multi-tasking

  • Will be required to learn and work with multiple software/hardware products (sometimes concurrently) during the course of an average work day

  • Must possess excellent communication skills, verbal and listening.

  • Must be able to maintain a professional demeanor in stressful situations.

  • Adept with machinery typically found in a business office environment.

  • Mathematical aptitude to make contractual calculations and estimate patient financial obligations.

  • Able to build productive relationships with all contacts.

  • Must be able to perform data entry with speed and accuracy

  • Knowledge of Medical Terminology is preferred.

  • Knowledge of benefits and language is preferred.

Requisition ID: 2021-86038

Street: 212 W Dale St

Name: 9010 Administration

Name: Patient Access

FTE (Numeric Only; Ex. 0.01): 1.0

FLSA Status: Non-Exempt

Scheduled Hours/Shift: 8am - 4:30pm, Monday - Friday

External Company URL: http://www.unitypoint.org

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