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
Street: 225 E Chicago Ave