Insurance Clearance Rep Senior

aah; Winston-Salem (NC); Remote; USD 48,000 - 71,000; Full time

Benefits offered by this job

Health and welfare benefits

Paid Time Off

Flexible Spending Accounts

Educational Assistance Program

Retirement plans with employer match

Job summary

Advocate Health seeks a remote Pre-Arrival Authorization Specialist to manage payer requirements and complete insurance authorizations for inpatient and outpatient services. You will gather clinical data, assign procedure codes, and support reimbursement decisions.

Responsibilities include coordinating with patients and departments on uninsured/out-of-network cases, verifying eligibility, and ensuring accurate ADT entries with proper carrier codes and benefits data.

Qualifications

• 2 years of experience in health care, insurance, call center, or customer service.
• Ability to solve problems in a high profile, high stress environment.
• Strong communication and organizational skills.

Responsibilities

• Acquires and maintains knowledge of payor requirements for authorization and hospital billing.
• Performs insurance authorization for inpatient and outpatient services with accurate data.
• Notifies patients of financial responsibility when authorization is not obtained.
• Ensures accurate patient registration data and HIPAA compliance.
• Engages in department meetings and continuing education to maintain competency.

Skills

Problem solving

Prioritization

Communication

Medical terminology

Anatomy knowledge

General computer knowledge

Education

High School Graduate

Job description

Department: 10338 Enterprise Revenue Cycle - PreArrival Authorization

Status: Full time

Benefits Eligible: Yes

Hours Per Week: 40

Fully Remote. Monday-Friday 8:30a-5p

Pay Range: $22.90 - $34.35

Major Responsibilities:

• Acquires and maintains current knowledge of all payor requirements as it relates to patient/hospital responsibility for authorizations and hospital billing, including all Federal and State regulations. Performs all insurance authorization of inpatient and outpatient services, by accurately collecting and analyzing clinical data in support of payor guidelines and submits accordingly. Uses resources to determine appropriate procedure codes for authorization to ensure appropriate reimbursement.


• Consults with patient and appropriate departments for uninsured status, uncovered services, out of network status and situations where the only insurance is Third Party Liability or Workers Compensation and provides next steps. Initiates communication to the patient when authorization is not obtained and explains the potential financial responsibility.


• Maintains knowledge of all stand-alone computer software programs to verify eligibility and authorization.


• Ensures completion of all established policies and procedures for identification and notification of the Primary Care Physician in the case of HMO coverage. Identifies at risk balances related to Medicaid eligibility rules and communicates to Financial Counseling, Utilization Management, and physicians. Completes cancelations and accurately reschedules patient according to department procedures.


• Manages incoming and outgoing calls to complete pre-registration with patients. Pre-registers and registers patients using established procedures for computer entry for all ancillary and nursing units, keeping current with the specialized needs, and preparing necessary documents/records when necessary. Ensures accurate entry of patient demographic and insurance information in the ADT system with special attention to carrier code assignment, complete benefit, eligibility record and authorization data.


• Generates and processes all required documents for completion of registration, providing detailed education to the patient on the documents and forms requiring patient signature.


• Participates in department staff meetings and keeps abreast of continuing education to ensure effective communication and to maintain skill competency. Seeks out education opportunities to increase knowledge in department procedures as it relates specifically to scheduling needs for that area.


• Attends all mandatory in-services 100% and completes all mandatory safety in-services and skill competencies as required. Actively participates in group projects to problem solve department issues.


• Operational knowledge of the various Advocate Aurora Health departments so that patient, visitor, and fellow employee questions are answered or referred in an appropriate manner. Maintains confidentiality of patients records by following HIPAA and all compliance policies and guidelines.

Licensure, Registration, and/or Certification Required:

• None Required.

Education Required:

• High School Graduate.

Experience Required:

• Typically requires 2 years of experience in health care, insurance industry, call center, or customer service setting.

Knowledge, Skills & Abilities Required:

• Ability to problem solve in a high profile and high stress area.


• Ability to prioritize and organize workload.


• Mathematical aptitude, effective communication, and critical thinking skills.


• Understanding of basic human anatomy and medical terminology.


• Excellent verbal and written communication skills.


• General computer knowledge.

Physical Requirements and Working Conditions:

• Must be able to sit most of the workday.


• May include intermittent light travel.


• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our CommitmenttoYou:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training


• Premium pay such as shift, on call, and more based on a teammate's job


• Incentive pay for select positions


• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs


• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability


• Flexible Spending Accounts for eligible health care and dependent care expenses


• Family benefits such as adoption assistance and paid parental leave


• Defined contribution retirement plans with employer match and other financial wellness programs


• Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.