Prior Authorization Specialist

Overview

Schedule: M-F (Day shift, 40 hours per week) This is a temporary position without guarantee of conversion to full-time employment.

Job Description

Summary: Coordinates patient accounts from prior authorization to point of bill payment or referral to collection, including processing billing for home health agencies to appropriate agencies, including Medicaid and self-pay. Maintains current knowledge of changes in billing requirements and regulations and assists in resolving billing problems.

Job Description

Essential Functions: Verifies patient insurance coverage and eligibility for homecare services. Processes and submits insurance claims for reimbursement. Communicates with patients, insurance companies, and healthcare providers to resolve billing issues. Maintains accurate and up-to-date patient records and billing information. Monitors and tracks outstanding claims and follows up on unpaid or denied claims. Ensures compliance with all relevant regulations and guidelines related to homecare billing and reimbursement. Education Requirement: High School Diploma or equivalent, required. Licensure Requirement: (not specified) Certifications: (not specified) Skills: (not specified) Experience: Two years ofexperience billing public and private insurers for medical services using computerized billing system, required. Homecare services experience, preferred. Physical Requirements: OCCASIONALLY: Flexing/extending of neck, Lifting / Carrying: 0-10 lbs, Standing, Walking FREQUENTLY: (none specified) CONTINUOUSLY: Audible speech, Color vision, Computer skills, Decision Making, Depth perception, Hand use: grasping, gripping, turning, Hearing acuity, Interpreting Data, Peripheral vision, Problem solving, Repetitive hand/arm use, Seeing – Far/near, Sitting Additional Physical Requirements performed but not listed above: Talking on the phone / in person Frequently (34 - 66%) "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 are seeking individuals who live these values and want to share their experiences and efforts in support of our collective mission. 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.