Job Title: Authorization Specialist

Company: Bon Secours Charity Medical Group

City/State: Stony Point, NY

Category: Clerical/Administrative Support

Department: Cardiology Consultant A

Position: Full Time

Shift: Days

Req #: 4808

Job Details:

The Authorization Specialist is responsible for performing complex clerical procedures related to verifying insurance information and obtaining authorization for inpatient admissions and specialized clinical procedures and treatments in accordance with established rules procedures, specified time frames, and regulatory requirements. The Specialist processes clinical information in a timely manner to prevent treatment delays and to avoid denials from third party payers and maintains confidentiality of patient information.

 RESPONSIBILITIES: 

  •  Enters and retrieves information from various automated systems and prepares specialized reports. 
  •  Collects demographic and insurance data and enters accurately in to specialized automated systems. 
  •  Prepares, reviews for completion, and maintains required documents in accordance with established procedures, time frames and regulatory requirements. 
  • Makes contacts to obtain missing information for incomplete forms.
  •  Advises patients and clinical staff of problems with insurance authorizations and re-submits requests with additional or revised information.
  • Verifies insurance eligibility with third party payers using internet websites and RTE. 
  • Contacts insurance providers to confirm level of benefits for inpatient admissions.
  •  Responds to customer inquiries and provides information.
  • Serves as liaison between the physician’s offices, patients, case management department and Patient Registration.
  •  Follows up with patients, physicians, clinical and ancillary departments to ensure optimum delivery of services.
  •  Communicates with case managers, hospital personnel, and external agencies to provide information or resolve discrepancies. 
  •  Reviews daily discharge statistics in ConnectCare software. 

QUALIFICATIONS/REQUIREMENTS: 

 Two to three years of clerical experience in health care field or related area required; experience in an outpatient setting preferred.

EDUCATION:

A high school diploma or equivalency required.

OTHER:

If applicable, the individual performing this job may reasonably anticipate coming into contact with human blood and other potentially infectious materials. Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control.

About Us:

Bon Secours Charity Medical Group

Bon Secours Charity Medical Group, part of Bon Secours Charity Health Systems (BSCHS), a regional network of more than 120 primary care physicians and specialists from a broad array of medical specialties. BSCHS, a member of WMCHealth Network, includes Good Samaritan Hospital in Suffern, NY, Bon Secours Community Hospital in Port Jervis, NY and St. Anthony Community Hospital in Warwick, NY.