BH Insurance/Precert Specialist

Nationwide Children's Hospital; Columbus (OH); On-site; USD 36,000 - 48,000; Full time

Job summary

Nationwide Children's Hospital is seeking a dedicated individual for a role focusing on verifying and documenting benefit information and ensuring optimal payment to the hospital and providers. Responsibilities include contacting insurance companies, documenting authorizations in Epic, and facilitating communication regarding denials and appeal options.

The ideal candidate will possess strong computer skills, excellent written communication abilities, and organization skills, with a high school diploma required and an Associate’s Degree preferred. There are opportunities to work on-site during the probation period.

Qualifications

• Strong ability to navigate current technology systems.
• Excellent written, communication, and organizational skills.

Responsibilities

• Verifies and documents benefit information.
• Obtains and verifies insurance prior authorization.
• Communicates authorization denials and appeal options.
• Participates in department meetings and resolves issues.
• Maintains knowledge of payer standards and requirements.

Skills

Strong computer skills

Excellent written communication

Organizational skills

Education

High school graduate

Associate’s Degree

Job description

Overview

Schedule: M-F (Day Shift)
On-site during probation period until cleared to work remote.

Job Description Summary

Verifies and documents benefit information. Requests initial authorization and meets provider’s referral requirements to ensure that optimum payment is made to the hospital and providers.

Essential Functions

• Contacts insurance companies to obtain and verify benefit information, documents all benefit information, and meets payer’s referral requirements to ensure that optimum payment to the hospital and providers will be satisfied.
• Obtains insurance prior authorization as needed and documents the verification of benefits and prior authorizations in Epic. Maintains record of pending prior authorizations and documents timely follow-up.
• Assists with the retrospective review of records for patients who have insurance changes that impact the authorization.
• Communicates authorization denials and appeal options to referral sources/Providers. Assists with coverage resources as appropriate.
• Contacts schedulers if insurance cannot be verified and refers self-pay patients to financial assistance resources.
• Participates in department and interdepartmental meetings to promote knowledge, troubleshoot, and resolve issues related to benefits or authorizations.
• Maintains knowledge of The Joint Commission, Medicaid, Medicare, and other third-party payer standards and requirements.

Education Requirement

• High school graduate, required.
• Associate’s Degree, preferred.

Licensure Requirement

(not specified)

Certifications

• CPR certification (based on position and as determined by manager).

Skills

• Strong computer skills required with the ability to navigate most current technology systems.

Experience

• Excellent written, communication, and organizational skills required.

Physical Requirements

• OCCASIONALLY: Bend/twist, Biohazard waste, Blood and/or Bodily Fluids, Chemicals/Medications, Communicable Diseases and/or Pathogens, Driving motor vehicles (work required) *additional testing may be required, Lifting / Carrying: 0-10 lbs, Lifting / Carrying: 11-20 lbs, Loud Noises, Patient Equipment, Pushing / Pulling: 0-25 lbs, Reaching above shoulder, Squat/kneel, Standing, Walking
• FREQUENTLY: Flexing/extending of neck, Hand use: grasping, gripping, turning
• CONTINUOUSLY: Audible speech, Color vision, Computer skills, Decision Making, Depth perception, Hearing acuity, Interpreting Data, Peripheral vision, Problem solving, Repetitive hand/arm use, Seeing – Far/near, Sitting
• Additional Physical Requirements Performed But Not Listed Above: Able to multi-task within in a stressful environment.

EOE M/F/Disability/Vet