St. Lawrence Health System
Finance and Authorization Specialist - Lead
St. Lawrence Health System, Rochester, New York, United States, 14618
Finance & Authorization Specialist
Department: Finance Location: Lipson Cancer Institute Rochester General Hospital - 1425 Portland Avenue, Rochester, NY 14621 Hours Per Week: 40 Schedule: Monday through Friday, Standard Business Hours Summary The primary responsibility of the Finance and Authorization Specialist is to promptly verify patient's insurance, obtain and verify if not provided, provide accurate patient estimate as requested, obtain or verify authorization for the procedures and treatments ordered by the department and ordering providers, and maintain communication to multiple departments with findings and issues. Responsibilities Utilize appropriate insurance verification tools to validate patient insurance eligibility. Generate timely patient estimates through the use of Rochester Regional Health's Estimate Tool. Support internal offices with generating estimates for future services, as requested. Deliver Price Estimates to patients in a courteous and knowledgeable manner. Deliver finalized estimate findings to patient via phone call, email, or MyCare channels. Obtain prior-authorization on both internal and external department orders for procedures/treatments performed in the department; applicable to both new and established patients.
Coordinate with Patient Registration to appropriately and accurately schedule patients in accordance with the provider's orders. Communicate with other departments to address scheduling or authorization issues. Complete forms and letters to insurance for visit coverage. Monitor daily schedules for add-on appointments, insurance changes, and work accordingly within our policies to verify insurance, process estimates, and/or obtain authorizations. Monitor pending authorizations and follow due process should it need to be rescheduled. Participate in orientation of new staff. Obtain referrals from payers that require it. Obtain insurance information through various searches when not in the system
Minimum Qualifications 2 years related work experience in a healthcare or insurance setting
Preferred Qualifications Previous experience with insurance verification and benefit application, familiarity with ICD-10 diagnosis, and procedure codes, and CPT/HCPCS codes.
Proficiency in a variety of computer applications, spreadsheet applications, and common office equipment.
Flexibility and ability to work as a team player
Ability to handle simultaneous tasks paying great attention to detail
Excellent communication skills including both oral and written as well as interpersonal skills.
Excellent problem solving and follow through skills.
Experience using EMR software
Additional basic computer skills required
Excellent customer service and communication skills required.
Education Licenses / Certifications Physical Requirements S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met. For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements. Any physical requirements reported by a prospective employee and/or employee's physician or delegate will be considered for accommodations. Pay Range $19.00 - $25.00 City: Rochester Postal Code: 14621 Rochester Regional Health is an Equal Opportunity/Affirmative Action Employer. Minority/Female/Disability/Veterans by a prospective employee and/or employee's Physician or delegate will be considered for accommodations.
Department: Finance Location: Lipson Cancer Institute Rochester General Hospital - 1425 Portland Avenue, Rochester, NY 14621 Hours Per Week: 40 Schedule: Monday through Friday, Standard Business Hours Summary The primary responsibility of the Finance and Authorization Specialist is to promptly verify patient's insurance, obtain and verify if not provided, provide accurate patient estimate as requested, obtain or verify authorization for the procedures and treatments ordered by the department and ordering providers, and maintain communication to multiple departments with findings and issues. Responsibilities Utilize appropriate insurance verification tools to validate patient insurance eligibility. Generate timely patient estimates through the use of Rochester Regional Health's Estimate Tool. Support internal offices with generating estimates for future services, as requested. Deliver Price Estimates to patients in a courteous and knowledgeable manner. Deliver finalized estimate findings to patient via phone call, email, or MyCare channels. Obtain prior-authorization on both internal and external department orders for procedures/treatments performed in the department; applicable to both new and established patients.
Coordinate with Patient Registration to appropriately and accurately schedule patients in accordance with the provider's orders. Communicate with other departments to address scheduling or authorization issues. Complete forms and letters to insurance for visit coverage. Monitor daily schedules for add-on appointments, insurance changes, and work accordingly within our policies to verify insurance, process estimates, and/or obtain authorizations. Monitor pending authorizations and follow due process should it need to be rescheduled. Participate in orientation of new staff. Obtain referrals from payers that require it. Obtain insurance information through various searches when not in the system
Minimum Qualifications 2 years related work experience in a healthcare or insurance setting
Preferred Qualifications Previous experience with insurance verification and benefit application, familiarity with ICD-10 diagnosis, and procedure codes, and CPT/HCPCS codes.
Proficiency in a variety of computer applications, spreadsheet applications, and common office equipment.
Flexibility and ability to work as a team player
Ability to handle simultaneous tasks paying great attention to detail
Excellent communication skills including both oral and written as well as interpersonal skills.
Excellent problem solving and follow through skills.
Experience using EMR software
Additional basic computer skills required
Excellent customer service and communication skills required.
Education Licenses / Certifications Physical Requirements S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met. For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements. Any physical requirements reported by a prospective employee and/or employee's physician or delegate will be considered for accommodations. Pay Range $19.00 - $25.00 City: Rochester Postal Code: 14621 Rochester Regional Health is an Equal Opportunity/Affirmative Action Employer. Minority/Female/Disability/Veterans by a prospective employee and/or employee's Physician or delegate will be considered for accommodations.