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Authorization Specialist I (Remote)>
Fairview Health Services • Remote • Posted 12 days ago
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Remote • Full-time • Mid Level
Job Highlights
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The Authorization Specialist I at Fairview Health Services is responsible for completing the financial clearance process within Patient Access, including understanding and working with multiple insurance payors to secure benefits and increase the likelihood of reimbursement. This role involves articulating payor information to patients, guarantors, and family members, completing insurance and benefits verification, screening payor medical policies, submitting and managing referral and authorization requests, and providing support for appeals and denials. The specialist works closely with medical staff, nursing, ancillary departments, insurance payors, and external sources to assist families in obtaining healthcare and financial services.
Responsibilities
- Performs financial clearance process by interviewing patients and collecting and recording all necessary information for pre-registration of patients.
- Ensures that proper insurance payor plan choice and billing address are assigned in the automated patient accounting system.
- Verifies relevant group/ID numbers
- Verifies insurance eligibility and completes automated insurance eligibility verification, documenting information in Fairview's patient accounting system.
- Determines the patient's insurance type and educates patients regarding coverage and/or coverage issues.
- Informs families with inadequate insurance coverage regarding financial assistance through government and Fairview financial assistance programs.
- Performs initial financial screening and refers accounts for financial counseling.
- Initiates treatment authorization requests and pursues referrals per payor guidelines.
- Reviews medical chart/history and physician order(s) to determine likely ICD and CPT codes.
- Reviews payor medical policies to determine if procedures meet medical necessity guidelines.
- Works with clinics and ancillary service departments if medical necessity fails.
- Follow up with insurance payors on prior authorization denials. Process authorization denial appeals, when necessary.
- Educates patients and attempts to collect co-payments, co-insurance, and deductibles per Fairview's POS collections policies and procedures
Qualifications
Required
- Four or more years of experience working in revenue cycle, insurance verification/eligibility, financial securing, or related areas in a health care setting.
- Experience with practice management software, hospital billing software or electronic health record software.
- Knowledge of insurance terminology, plan types, structures, and approval types
- Knowledge of computer systems, including Microsoft Office 365
Preferred
- Referrals and/or prior authorization experience
- Epic experience
- Knowledge of medical terminology and clinical documentation review
About Fairview Health Services
Fairview Health Services is a nonprofit health care system with a large workforce providing medical services through thousands of aligned physicians.
Full Job Description
**Overview**
This position is responsible for completing the financial clearance process within Patient Access. It requires understanding of and working with multiple insurance payors to secure benefits and increase the likelihood of reimbursement for Fairview at the highest benefit level.
The Financial Clearance Representative (FCR) must be able to effectively articulate payor information in a manner such that patients, guarantors, and family members gain a clear understanding of their financial responsibilities.
The FCR will be responsible for completing the insurance and benefits verification to determine the patient's benefit level. They will screen payor medical policies to determine if the scheduled procedure meets medical necessity guidelines, submit, and manage referral and authorization requests/requirements when necessary, and/or ensure that pre-certification and admissions notification requirements are met per payor guidelines. They will provide support and process prior authorization appeals and denials, when necessary, in conjunction with revenue cycle and clinical staff.
The FCR makes the decision when and how to work with medical staff, nursing, ancillary departments, insurance payors and other external sources to assist families in obtaining healthcare and financial services.
**Responsibilities Job Description**
**Registration:**
+ Performs financial clearance process by interviewing patients and collecting and recording all necessary information for pre-registration of patients.
+ Ensures that proper insurance payor plan choice and billing address are assigned in the automated patient accounting system.
+ Verifies relevant group/ID numbers
**Financial Screening:**
+ Verifies insurance eligibility.
+ Completes automated insurance eligibility verification, when applicable and appropriately documents information in Fairview's patient accounting system.
+ Determines the patient's insurance type and educates patients regarding coverage and/or coverage issues.
+ Informs families with inadequate insurance coverage regarding financial assistance through government and Fairview financial assistance programs.
+ Performs initial financial screening and refers accounts for financial counseling.
+ Initiates treatment authorization requests and pursues referrals per payor guidelines.
+ Reviews medical chart/history and physician order(s) to determine likely ICD and CPT codes.
+ Reviews payor medical policies to determine if procedures meet medical necessity guidelines.
+ Works with clinics and ancillary service departments if medical necessity fails.
+ Follow up with insurance payors on prior authorization denials. Process authorization denial appeals, when necessary.
**Point of Service Collection:**
+ Educates patients and attempts to collect co-payments, co-insurance, and deductibles per Fairview's POS collections policies and procedures
**Qualifications**
R **equired**
+ Four or more years of experience working in revenue cycle, insurance verification/eligibility, financial securing, or related areas in a health care setting.
+ Experience with practice management software, hospital billing software or electronic health record software.
+ Knowledge of insurance terminology, plan types, structures, and approval types
+ Knowledge of computer systems, including Microsoft Office 365
**Preferred**
+ Referrals and/or prior authorization experience
+ Epic experience
+ Knowledge of medical terminology and clinical documentation review
**EEO Statement**
EEO/AA Employer/Vet/Disabled: All qualified applicants will receive consideration without regard to any lawfully protected status
This position is responsible for completing the financial clearance process within Patient Access. It requires understanding of and working with multiple insurance payors to secure benefits and increase the likelihood of reimbursement for Fairview at the highest benefit level.
The Financial Clearance Representative (FCR) must be able to effectively articulate payor information in a manner such that patients, guarantors, and family members gain a clear understanding of their financial responsibilities.
The FCR will be responsible for completing the insurance and benefits verification to determine the patient's benefit level. They will screen payor medical policies to determine if the scheduled procedure meets medical necessity guidelines, submit, and manage referral and authorization requests/requirements when necessary, and/or ensure that pre-certification and admissions notification requirements are met per payor guidelines. They will provide support and process prior authorization appeals and denials, when necessary, in conjunction with revenue cycle and clinical staff.
The FCR makes the decision when and how to work with medical staff, nursing, ancillary departments, insurance payors and other external sources to assist families in obtaining healthcare and financial services.
**Responsibilities Job Description**
**Registration:**
+ Performs financial clearance process by interviewing patients and collecting and recording all necessary information for pre-registration of patients.
+ Ensures that proper insurance payor plan choice and billing address are assigned in the automated patient accounting system.
+ Verifies relevant group/ID numbers
**Financial Screening:**
+ Verifies insurance eligibility.
+ Completes automated insurance eligibility verification, when applicable and appropriately documents information in Fairview's patient accounting system.
+ Determines the patient's insurance type and educates patients regarding coverage and/or coverage issues.
+ Informs families with inadequate insurance coverage regarding financial assistance through government and Fairview financial assistance programs.
+ Performs initial financial screening and refers accounts for financial counseling.
+ Initiates treatment authorization requests and pursues referrals per payor guidelines.
+ Reviews medical chart/history and physician order(s) to determine likely ICD and CPT codes.
+ Reviews payor medical policies to determine if procedures meet medical necessity guidelines.
+ Works with clinics and ancillary service departments if medical necessity fails.
+ Follow up with insurance payors on prior authorization denials. Process authorization denial appeals, when necessary.
**Point of Service Collection:**
+ Educates patients and attempts to collect co-payments, co-insurance, and deductibles per Fairview's POS collections policies and procedures
**Qualifications**
R **equired**
+ Four or more years of experience working in revenue cycle, insurance verification/eligibility, financial securing, or related areas in a health care setting.
+ Experience with practice management software, hospital billing software or electronic health record software.
+ Knowledge of insurance terminology, plan types, structures, and approval types
+ Knowledge of computer systems, including Microsoft Office 365
**Preferred**
+ Referrals and/or prior authorization experience
+ Epic experience
+ Knowledge of medical terminology and clinical documentation review
**EEO Statement**
EEO/AA Employer/Vet/Disabled: All qualified applicants will receive consideration without regard to any lawfully protected status
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