VA Auditing Specialist

St. Joseph’s/Candler Health System; Savannah (GA); Hybrid; USD 42,000 - 62,000; Full time

Job summary

St. Joseph’s/Candler Health System in Savannah, GA is seeking a VA Auth/Referral and Auditing Specialist to verify patient insurance coverage, obtain necessary prior authorizations, and review medical records to determine policy coverage, ensuring timely access to care while managing the financial aspects of treatment.

The role supports departments such as LCRP, Patient Accounts, Pre-Service and Registration, with emphasis on HIPAA compliance, accurate EMR documentation, and proactive denial

Qualifications

• High School Diploma preferred.
• 1-3 years Insurance experience required.
• 2-3 years Medical background preferred.

Responsibilities

• Maintains patient records in an organized and secure manner, ensuring HIPAA regulations are followed.
• Determines precertification necessity and coordinates with insurance companies to maximize reimbursement.
• Monitors reports for precertification needs and conducts initial and concurrent reviews until precertification is obtained.
• Documents precertification and payer correspondence in the EMR and ensures front desk staff collects referral information to limit denials.
• Records missing or incorrect authorizations and investigates delays in patient treatment.

Skills

HIPAA compliance

Attention to detail

Interdepartmental communication

Education

High School Diploma

Tools

EMR system

Job description

A VA Auth/Referral and Auditing Specialist is responsible for verifying patient insurance coverage, obtaining necessary prior authorizations for medical services from insurance companies, by reviewing medical records and determining if requested procedures are covered based on policy guidelines, ultimately ensuring timely access to care for patients while managing the financial aspects of their treatment. While auditing for accuracy and validity of all authorizations or referrals for VA and Tricare. The VA Auth/Referral and Auditing Specialist will be overlooking authorizations and referral within departments such as: LCRP, Patient Accounts, Pre-Service and Registration.

Education

High School Diploma - Preferred

Experience

1-3 Years Insurance experience - Required

2-3 Years Medical background - Preferred

License & Certification

None Required

Core Job Functions

• Demonstrates responsibility in maintaining patient records in organized and secure manner. Ensures HIPAA regulations are continuously followed.
• Determines precertification necessity. Communicates and coordinates with insurance companies to maximize reimbursement. Communicates with other departments to eliminate denials from insurance companies.
• Monitor various reports for precertification need. Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
• Documents within EMR and hospital charting system data on precertification and payer correspondence. Ensures appropriate referral information is taken by the front desk staff to limit denial of services
• Accurately measures and records the type, frequency, and responsibility for missing or inaccurate authorizations, navigation or any other insurance benefit related issue that causes delays in the patient treatment schedule.

Learn more about the many benefits available to SJ/C co-workers. From wellness programs and insurance options to child care and housing opporunities, SJ/C invests in the health and well-being of our co-workers in many ways.