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Ann & Robert H. Lurie Children's Hospital of Chica Prior Authorization Specialist, Financial Clearance I in Chicago, Illinois

The Financial Clearance I secures required precertification/prior authorizations for ambulatory, inpatient, outpatient surgery, and admissions cases. Interprets and obtains data for medical necessity and precertification compliance; calculates, explains, and collects patient liabilities; and completes third-party eligibility and benefit verification in order to ensure compliance with government/regulatory and third-party payer requirements, and to ensure prompt and accurate billing and payment of hospital accounts receivable.

  • Ensures pre-certifications are completed prior to visit for all scheduled appointments.

  • Manages precertification cases for outpatient surgery, admission authorizations, radiology, sleep studies, and referrals for office visits.

  • Maintains current knowledge of insurance requirements, benefit provisions and pre-certification.

  • Contacts patient and/or division teams to provide updates on precertification status and timeliness.

  • Generates patient estimates and contacts patient to provide details on patient financial responsibility.

  • Updates patient’s registration information as needed.

  • Consistently meets quality and productivity requirements.

  • Other job functions as assigned.

  • High school graduate required; BS or BA preferred.

  • Excellent communication/listening skills.

  • Demonstrates knowledge of utilization management process including communication with payors and benefit authorization for applicable situations.

  • Experience reviewing medical charts/records and abstracting relevant clinical data to support medical necessity of scheduled procedures.

  • Minimum two years’ experience in pre-certification initiation in a hospital/facility setting or physician office environment working precertification for inpatient, outpatient, outpatient surgery and admissions.

  • Knowledge of medical terminology, third party billing, utilization management and managed care requirements.

  • Proficient computer skills and aptitude.

  • Substantial interpersonal skills sufficient to work effectively with pediatric patients, families, physicians, nursing and other allied health and medical center personnel.

  • Problem solving ability and able to handle multiple priorities.

Requisition ID: 2019-11269

Shift: Day/Evening

Street: 225 E Chicago Ave