The Scheduling & Auth Specialist 2 is responsible for financially clearing insurance verifications for all services and patient financial classifications, reviewing medical records, interfaces with payers to extend authorization for treatment, collaborates with Patient Business Office (PBO), assists with reimbursement and authorization according to contracts, and supports the denials and appeals process. Obtains pertinent documentation to support authorization requests.
Serves as the liaison between PBO, Central Authorization, physicians, outside medical groups (OMG), various insurance carriers, patients, and all departments for office visits, in-patient, and out-patient services. The duties outlined in this
will be an important part of our Hospital Outpatient Department strategy for the delivery of care that is consistent with our mission, vision, and values. This role is therefore accountable to the governance structure of the (Loma Linda University Medical Center) (Loma Linda University Children's Hospital). Performs other duties as needed.
Education and
Associate's Degree required. Minimum three years of related experience required. Minimum one year of healthcare experience preferred.
Experience may be considered in lieu of degree. Knowledge and
Knowledge of various insurance types and their guidelines, including the ability to read and interpret EOB's. Working knowledge of current ICD and CPT coding systems. Able to read; write legibly; speak in English with professional quality; use computer, printer, and software programs necessary to the position (e.g., Word, Excel, Outlook, PowerPoint).
Operate/troubleshoot basic office equipment required for the position. Essential Interpersonal
Able to relate and communicate positively, effectively, and professionally with others; work calmly and respond courteously when under pressure; collaborate and accept direction. Able to communicate effectively in English in person, in writing, and on the telephone; think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision.
Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone and identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, and written documents necessary to the position. Licensures and
Medical coding certification preferred.