Preauthorization Specialist

Under
the direction of the Financial Coordinator Supervisor, ensures that all information necessary for proper
financial reimbursement for high dollar patient care is analyzed and submitted
to insurance companies for approval prior to the patient's date of service. Collaborates
with insurance companies and physician offices when necessary to verify
eligibility and authorization requirements to ensure financial reimbursement
for services.

• Perform
  all insurance verification for eligibility, coverage, and authorization
  requirements via Web or phone with third party payers.

• Ensures
  all possible coverages are created and verified, through electronic or
  manual methods, and all discrepancies are resolved. Validates that
  coverages are assigned to appropriate visit. -Collects and validates
  order-related information including office visit, radiology and surgical
  orders. Follows up with ordering provider to verify CPT codes.
• Escalates
  challenging accounts to team lead to ensure accounts are approved at prior
  to patient appointment/surgery. Escalates non-certified urgent cases to
  appropriate clinical departments and leadership for approval to proceed or
  communicate rescheduling.

• Contacts providers and
  insurance companies to validate data, collect missing information and resolve
  information discrepancies, -Understands clinical guidelines for payors
  requiring authorization to better build cases for authorization requests and
  provide feedback to clinical departments on required notes.

• Work
  closely with physician offices obtaining authorization for inpatient and
  outpatient services

• High
  school graduate or equivalent; some college preferred

  Experience

• 1-2 years of insurance, third party payor or secretarial
  experience in a health care setting required

  Knowledge
  and Skills

• Medical
  Terminology required

• Analytical
  ability to gather and interpret data and communicate desired outcomes orally
  and in writing in a professional manner

• Strong
  communication and interpersonal skills

• Ability
  to handle multiple duties

Newton-Wellesley
Hospital will provide equal employment opportunities to all applicants and
employees without regard to race, color, religion, gender age, national origin,
disability, marital status, genetic information, veteran or active military
status, gender identity or expression, or sexual orientation.