Prior Authorization Specialist (2:30pm-11:00pm with rotating weekends)

Status: Full-time, 40-hours per week

Schedule: Evening Shift, 2:30pm-11:00pm with rotating weekends

Location: 4390 Parliament Place, Lanham, MD 20706 (Transfer Center)

Must be available for mandatory training schedule in the first 90-days of employment: Tuesday-Wednesday, 8:00am-4:30pm (2 consecutive days, 1 week only). 

 General Summary of Position
Responsible for primary value patients accounts prior to billing. Obtains financial clearance authorizations insurance benefits and eligibility for designated department accounts. Interacts with patients and/or representatives in providing information associated with medical insurance coverage and financial responsibility.

Primary Duties and Responsibilities

• Communicates timely updated insurance information to appropriate departmental parties. May assist registration with appropriate insurance guidance as needed. Stays up-to-date on insurance procedure and benefit changes and attends insurance seminars when available. Identifies insurance issues and provides feedback to appropriate supervisor.
• Completes preadmission/pre-registration maintenance of reservation files. Acts as a resource person to other departments public and physicians concerning financial/insurance matters. Updates online computer files (SMS).
• Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
• Counsels patient or representative as needed concerning: substantial unpaid or non-covered charges (preadmission ASU POP and concurrent admission); specific insurance coverage terms and limits (deductibles co-insurance etc); clarification of patient or guarantor responsibility to pay bill. Identifies accounts requiring insurance authorizations and benefits. Calls insurance companies and utilizes online insurance verification systems in a timely manner. May use CPT and ICD9 coding books as a resource when needed by insurance carriers.
• May interview patient or representative to: obtain basic patient demographic and financial information required for registration and secure supplemental data concerning specific third party coverage.
• Obtains the authorizations required to provide service. Ensures needed forms and signatures are obtained according to predetermined regulations and/or hospital policies. Notifies and secures HMO approvals. Screens and refers patients to advocacy when needed. Notifies and collects deposits (copays deductible etc.) from patients. Adheres to MedStar Financial Assistance Policy and procedures. Follows established Cash Reconciliation policy guidelines and may complete daily departmental deposit.
• Verifies analyzes interprets and documents patient health insurance coverage health plan provisions or other third party hospital payment arrangements. Utilizes online verification tools.
• Participates in meetings and on committees and represents the department and hospital in community outreach efforts. Participates in multidisciplinary quality and service improvement teams.

Minimal Qualifications
Education

• High School Diploma or GED required
• Knowledge of medical terminology preferred

Experience

• 1-2 years Related experience required and
• Medical terminology preferred

Knowledge Skills and Abilities

• Proficient use of hospital registration and support systems.
• Working knowledge of various computer software applications.
• Good analytical and problem-solving skills.
• Excellent customer service skills.
• Excellent organizational skills to manage multiple tasks in a timely manner.
• Ability to work independently and as a member of a team.
• Ability to work with third party payors.
• Verbal and written communication skills.