Orthopedic Authorization & Payer Relations Specialist

The Nemours Foundation; Wilmington (DE); On-site; USD 55,000 - 75,000; Full time

Job summary

The Nemours Foundation is looking for an Orthopedic Authorization Liaison in Wilmington, DE. This role is focused on optimizing payments for services through effective management of referrals and authorizations for orthopedic patients, addressing issues with insurance providers.

You will work closely with hospital and physician departments, utilize EPIC applications, and maintain accurate documentation of communications. Ideal candidates should have significant experience and relevant certifications.

Qualifications

• High School Diploma or equivalent required; Associate's Degree preferred.
• Certified Revenue Cycle Representative (CRCR) and/or Certified Healthcare Financial Professional (CHFP) is required.
• Minimum five years of referral and/or authorization experience is required.

Responsibilities

• Ensure timely notification and request for authorization/referrals.
• Verify patient demographics, insurance eligibility, benefits, and financial responsibility.
• Contact families and primary care providers to obtain necessary information.

Skills

Knowledge of insurance authorization requirements

Communication skills

Data analysis and reporting

Epic applications utilization

Medical terminology knowledge

Education

High School Diploma or equivalent

Associate's Degree

Certified Revenue Cycle Representative (CRCR)

Certified Healthcare Financial Professional (CHFP)

SuperUser certification

Job description

The Nemours Foundation is looking for an Orthopedic Authorization Liaison in Wilmington, DE. This role is focused on optimizing payments for services through effective management of referrals and authorizations for orthopedic patients, addressing issues with insurance providers.

You will work closely with hospital and physician departments, utilize EPIC applications, and maintain accurate documentation of communications. Ideal candidates should have significant experience and relevant certifications.