Prior Auth Specialist

10 Nationwide Children's Hospital; United States; Vor Ort; USD 22.000 - 30.000; Teilzeit

Zusammenfassung

Nationwide Children’s Hospital in Columbus is seeking a part-time Pre-Authorization Clerk to support the revenue cycle. This 20-hour-per-week role requires reliable communication with providers, clinics, and third-party payers.

You will document pre-authorizations, enter data in HIS Work Queues, and assist with billing issues. A High School Diploma is required; Associate’s degree is preferred; strong customer service is essential.

Qualifikationen

• High School Diploma or equivalent required; Associate's Degree preferred.
• Excellent customer service and communication skills.
• Ability to understand and retain complex, changing information.
• Knowledge of the revenue cycle and its impact on operations.
• Familiarity with medical terminology.

Aufgaben

• Process pre-authorization documentation and obtain necessary records.
• Document information in the hospital information system (HIS).
• Contact third-party payers for pre-authorizations and provide updates.
• Review pending pre-authorizations and follow up as needed.
• Coordinate with clinics when peer-to-peer is requested and review progress.
• Assist Patient Accounts with billing issues related to pre-authorizations.

Kenntnisse

Customer service

Communication skills

Problem solving

Teamwork

Attention to detail

Ausbildung

High School Diploma

Associate's Degree (preferred)

Tools

HIS Work Queues

Jobbeschreibung

Overview

THIS IS A PART TIME ROLE, 20 HOURS PER WEEK. There is some flexibility with hours however the candidate will need to be available to work on Mon & Fri's

Job Description Summary

Processes pre-authorizations of exams or services ordered by Providers and performed at any NCH facility. Ensures that pre-authorizations are completed appropriately through communication to third party payers and collaboration with clinics.

Job Description

Essential Functions:

• Participates in pre-authorization documentation process, obtaining, compiling, maintaining, and issuing necessary records, reports, ensuring accuracy of content and correct distribution.
• Documents pre-authorization information appropriately in the hospital information system (HIS).
• Contacts third party payer to obtain pre-authorization for ordered exam, providing updates as needed throughout the pre-authorization process.
• Reviews pending pre-authorizations and provides follow up if needed.
• Communicates to clinics when peer to peer is requested and reviews clinic progress on pre-authorizations that require additional detail for approval.
• Provides additional information requested by Patient Accounts to assist in billing issues involving pre-authorization.

Education Requirement

• High School Diploma or equivalent, required.
• Associate's Degree, preferred.

Skills

• Excellent customer service and communication skills.
• Ability to work and problem solve with minimal supervision.
• Ability to understand and retain complex and quickly changing information.
• Knowledge of the impact of the revenue cycle on hospital operations.
• Familiarity with medical terminology.
• Ability to function as a team member responsible for staffing operational hours.
• Ability to adapt to change positively in workflow and process.
• Keyboarding, typing, or data entry skills.

Experience

• One year of pre-registration, registration, admitting, or customer service experience, preferred.
• One year of experience in billing processes and insurance verification, preferred.

Working knowledge of HIS Work Queues.

Physical Requirements

• OCCASIONALLY: Decision Making, Standing, Walking
• FREQUENTLY: Interpreting Data
• CONTINUOUSLY: Audible speech, Computer skills, Flexing/extending of neck, Hand use: grasping, gripping, turning, Hearing acuity, Peripheral vision, Problem solving, Repetitive hand/arm use, Seeing – Far/near, Sitting

The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision.

EOE M/F/Disability/Vet

The moment you walk through our doors, you feel it. When you meet our patient families, you believe it. And when you talk with anyone who works here, you want to be part of it. Welcome to Nationwide Children’s Hospital, Where Passion Meets Purpose. Here, Diversity, Equity and Inclusion are integrated into our core values and practices. We are passionate about building, sustaining and evolving an inclusive and equitable environment. We’re 15,000 strong. And it takes every one of us to improve the lives of the kids we care for, and the kids around the world we’ll never meet. Kids who live healthier, fuller lives because of the knowledge we share. We know it takes a Collaborative Culture to deliver on our promise to provide the very best, innovative care and to foster new discoveries, made possible by the most groundbreaking research. Anywhere. Ask anyone with a Nationwide Children’s badge what they do for a living. They’ll tell you it’s More Than a Job. It’s a calling. It’s a chance to use and grow your talent to make an impact that truly matters. Because here, we exist simply to help children everywhere. Nationwide Children’s Hospital. A Place to Be Proud.