Prior Authorization & Revenue Cycle Specialist

University Hospitals; Shaker Heights (OH); Vor Ort; USD 55.000 - 75.000; Vollzeit

Zusammenfassung

University Hospitals in Ohio is seeking a Revenue Cycle PreCert Specialist to secure insurance authorizations before services are provided. You will verify eligibility, submit requests, and partner with clinical teams to keep the authorization process moving smoothly.

The role emphasizes attention to detail, clear communication with patients, providers, and payers, and adherence to HIPAA and organizational policies as you help reduce delays and support timely reimbursement.

Qualifikationen

• Strong attention to detail and accuracy in processing authorizations.
• Excellent verbal and written communication with patients, providers, and payers.
• Ability to manage multiple tasks and priorities in a fast-paced environment.

Aufgaben

• Obtain and verify prior authorizations for outpatient testing, ambulatory procedures, and inpatient services before care is delivered.
• Review insurance eligibility, coverage, benefits, and payer requirements to help ensure services are authorized and reimbursable.
• Use electronic eligibility tools, payer websites, and direct communication with insurance companies to verify coverage and resolve authorization needs, including out-of-network and non-covered services.
• Submit authorization requests, notifications, clinical documentation, and supporting information in accordance with payer guidelines and contractual requirements.
• Partner with providers, clinical teams, and operational departments to gather necessary documentation and keep the authorization process moving efficiently.
• Communicate authorization updates, potential delays, denials, and peer-to-peer review requests while following established policies and escalation procedures.
• Provide excellent customer service through professional communication with patients, providers, payers, and internal team members via phone, email, and other correspondence.
• Stay current on insurance regulations, managed care requirements, government payer guidelines, and Revenue Cycle policies to support accurate and compliant work.
• Scan, retrieve, and maintain required documentation within electronic systems.
• Participate in team meetings, training, and ongoing learning opportunities while maintaining the highest standards of patient and physician confidentiality.
• Meet established quality, productivity, and service standards that support the success of the Revenue Cycle team.

Kenntnisse

Attention to detail

Communication skills

Multitasking

Jobbeschreibung

University Hospitals in Ohio is seeking a Revenue Cycle PreCert Specialist to secure insurance authorizations before services are provided. You will verify eligibility, submit requests, and partner with clinical teams to keep the authorization process moving smoothly.

The role emphasizes attention to detail, clear communication with patients, providers, and payers, and adherence to HIPAA and organizational policies as you help reduce delays and support timely reimbursement.