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Authorizes and pre-certifies services by coordinating and performing activities required for verification and authorization of insurance benefits. Proactively identifies resources available for families if health plan does not include coverage for services. Coordinates counseling services with Financial Counseling and ensures the standards of Surprise Billing is communicated.
Collaborates with Patient Financial Services (PFS) and Managed Care department regarding denied claims. May initiate and perform revenue cycle activities required for pre-registration. Works collaboratively with team members to provide quality service that ensures delivery of safe patient care and services.
Experience One year of experience in a healthcare patient access role (registration, scheduling)
Bachelor's degree Experience in a pediatric hospital Education High school diploma or equivalent Certification Summary No professional certifications required Knowledge, Skills, and Abilities Working knowledge of basic medical terminology Demonstrated ability to multitask and problem-solve Ability to work independently in a changing environment and handle stressful situations Must be able to speak and write in a clear and concise manner to convey messages Proficient in Microsoft Word/Excel/Outlook Knowledge of Availity, MMIS and insurance payer website.
May require travel within Metro Atlanta area as needed
Interviews patients and/or family members to secure insurance coverage, eligibility, and qualification for various financial programs. Coordinates and performs verification of insurance benefits by contacting insurance provider and determining eligibility of coverage and communicates status of verification/authorization process with appropriate team members in a timely and efficient manner. Provides clinical information as needed, emphasizing medical justification for procedure/service to insurance companies for completion of pre- certification process.
Confirms referring physician and/or servicing physician has obtained notification/confirmation of prior authorization as needed from insurance company for all scheduled healthcare procedures within assigned department/area. Contacts referring physicians and or/patients to discuss rescheduling of procedures due to incomplete/partial authorizations. Acts as liaison between clinical staff, patients, referring physician’s office, and insurance by informing patients and families of any possible changes, updates, responses or follow-up.
Discussion points may include the following: authorization delays, authorization denials, pending status, answering questions regarding status changes, offering assistance, providing follow up steps for financial support and relaying/documenting messages pertaining to authorization of procedure/service. Monitors patients on schedule, ensuring that eligibility and authorization information has been entered into data entry systems.
Pre-screens doctor’s orders (scripts) received for new patients to ensure completeness/appropriateness of scheduled appointment. Collaborates with Patient Financial Services (PFS) department to provide all related information regarding denied claims. Monitors insurance authorization issues to identify trends and participates in process improvement initiatives.
Responds to all inquiries related to authorization/pre-certification issues. Develops and maintains knowledge in medical terminology, billing and insurance guidelines to ensure Children’s remains compliant with all regulatory expectations. Children’s Healthcare of Atlanta is an equal opportunity employer committed to providing equal employment opportunities to all qualified applicants and employees without regard to race, color, sex, religion, national origin, citizenship, age, veteran status, disability or any other characteristic covered by applicable law.
Primary Location Address 1575 Northeast Expy NE Job Family Patient Access