Financial Investigator

BronxCare Health System; New York (NY); On-site; USD 48,000 - 64,000; Full time

Job summary

BronxCare Health System is seeking a Pre-Authorization Specialist to ensure timely processing of pre-authorizations for medical and ancillary services. You will work daily with practice managers, clinicians, and staff to confirm visits are properly registered and compliant with insurance requirements, while supporting CQI and risk management efforts.

The role requires strong customer service, solid computer skills, and experience in hospital billing or insurance verification.

Qualifications

• Two years of hospital/healthcare experience in financial investigations, insurance verification, or authorization.
• High school diploma or GED.
• Associates degree.

Responsibilities

• Obtain and process pre-authorization, authorization, and pre-certification requests for medical and ancillary services.
• Establish and maintain positive relationships with patients, visitors, and staff.
• Respond to inquiries from practice managers, clinicians, and PFS staff to ensure visits are properly registered and authorized.
• Navigate Allscripts EMR and retrieve required utilization data to facilitate insurance carrier review and expeditious approval.
• Maintain reporting on productivity and outstanding items; follow up on open cases as needed.

Skills

Customer service

Communication

Attention to detail

Education

High School or GED

Associate's degree

Tools

Allscripts EMR

Job description

Overview

Secure pre-authorizations for medical and ancillary services. Communicate on a daily basis with practice managers, clinicians and staff to ensure that visits are appropriately registered, and meet all insurance pre-authorization requirements.

Responsibilities

• Establish and maintain positive relationships with patients, visitors, and other employees. Interacts professionally, courteously, and appropriately with patients, visitors and other employees. Behaves in a manner consistent with maintaining and furthering a positive public perception of BronxCare Health System and its employees.
• Contributes to and participates in the Performance/Quality Improvement activities of the assigned department. Contribution and participation includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality Improvement (CQI) teams, consistent adherence to the specific rules and regulations of the BronxCare Health System (a) Safety and Security Policies, (b) Risk Management: Incident and Occurrence Reporting, (c) Infection Control Policies and Procedures and (d) Patient and Customer Service.
• Insures authorization requests are obtained and processed for medical and ancillary services on a timely basis and manage the accurate submission of authorization requests and the entry of authorization to Allscripts Clinical Registration System
• Responds in a timely manner to the pre-authorization, authorization and pre-certification requests of various points of service areas located within BronxCare Health System’s ambulatory practices.
• Retrieves and reviews patient utilization data to secure authorization for scheduled services. Updates BxCare practice administrative personnel and Care Providers regarding authorization decisions rendered by insurance carriers
• Navigates Allscripts EMR (Acute Care) and communicates with Practice Administrative staff or Care providers to retrieve required clinical utilization data to facilitate insurance carrier review and expeditious authorization approval
• Communicate on a daily basis with practice managers, clinicians and PFS staff to ensure that visits are appropriately registered, meet all insurance pre-authorization requirements and increase revenue by reducing payment denials for unauthorized services.
• Maintains accurate and complete reporting deliverables showing productivity and outstanding items to be addressed, conducts follow up on outstanding cases as needed.
• Act as a liaison with clinics, physicians, patients, staff, insurers and ancillary departments and maintain a positive relationship with all.
• Maintain the highest level of professionalism and confidentiality at all times to ensure compliance with Federal/State regulations such as HIPAA and EMTALA..

Qualifications

• Minimum Two (2) years' experience of Hospital/Healthcare in Financial Investigations and/or Insurance Verification and/or Insurance Authorization
• Excellent Customer Service Skills
• High School or GED
• Associates
• Basic Computer knowledge