At Bon Secours Mercy Health, we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence.
Insurance Authorization Specialist - Full-Time, Outpatient PT/OT/ST
Position acts as the central liaison between outpatient therapy and managed care payors to obtain and track required authorization for upcoming therapy services; the associate is expected to maintain current knowledge of payer authorization requirements for outpatient therapy services. This role supports timely and accurate claim submission and reimbursement by proactively submitting and tracking all new authorization request following initial therapy assessment and assisting in the reauthorization or extension process for upcoming therapy dept procedures. The associate is expected to maintain up-to-date account documentation of all payer authorization communication and up to date authorization status.
Essential Job Functions
Responsible for confirming and satisfying all authorization billing requirements for therapy services by obtaining appropriate precertification/authorization from all necessary payers to avoid delays in patient treatment and prevent claims denials for missing/invalid pre-certification/authorization.
Duties include monitoring assigned Authorization/Referral work queues. understanding payor guidelines for authorization/referral policies, timely submission, tracking and documentation of all precertification/authorizations required for upcoming services, based on therapy plan of care.
Screens and analyzes patient medical records, in EMR system, for required provider documentation to ensure medical necessity requirements are met in accordance with payor guidelines and any other contractual authorization entity.
Responsible for the timely submission, tracking and documentation of all precertification/authorizations required for upcoming services, based on outlined therapy plan of care.
Maintain current understanding of payor guidelines for authorization/referral policies.
Maintains confidentiality when working with patient accounts, protected health information, and release of records. Complies with HIPPA guidelines to protect patient data privacy.
Full Time Position - Virginia Beach, VA - In Office Position
Required Minimum Education:
High School Diploma or GED
Preferred Education:
2 Year/ Associates Degree
Licensure/Certification Required:
Required to obtain CRCR within 6 months of hire
Licensure/Certification Preferred:
CRCR
Minimum Qualifications
Minimum Years and Type of Experience:
Two years in a medical secretarial or patient access position preferred
Other Knowledge, Skills and Abilities Required:
Ideal candidates will have experience with ICDM-CPT coding, posting charges, data entry, knowledge of medical terminology preferred but not required.
Other Knowledge, Skills and Abilities Preferred:
Must possess excellent organizational, verbal communication and strong interpersonal skills. Demonstrates a high level of integrity, trust and displays exceptional customer service.
Many of our opportunities reward* your hard work with:
Comprehensive, affordable medical, dental and vision plans
Prescription drug coverage
Flexible spending accounts
Life insurance w/AD&D
Employer contributions to retirement savings plan when eligible
Paid time off
Educational Assistance
And much more
*Benefits offerings vary according to employment status
All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Mercy Health - Youngstown, Ohio or Bon Secours - Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email recruitment@mercy.com . If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment@mercy.com
