Preauthorization Specialist - Oakland, United States - Children's Hospital & Research Center Oakland

Description

Position Summary: The Preauthorization Specialist is responsible for the insurance verification process of verifying patient eligibility and benefits, obtaining prior authorizations, approval for planned inpatient and outpatient surgeries. This position is responsible for providing financial clearance and determining patient coverage responsibility. In addition, this position is accountable for completing preregistration functions as well as supports daily registration functions.


Position Requirements:


Education: High School Diploma, GED, or equivalent
Experience: 2 years experience in healthcare with experience processing authorization required


Knowledge, Skills, Abilities:

Demonstrates knowledge of all authorization and eligibility requirements. Strong understanding of the financial clearance process for all scheduled procedures. Ability to resolve denials in an effective and timely manner. Demonstrates knowledge of PPO's, HMOs, Medicare, and Medi-Cal guidelines for authorization requirements and pre-registration criteria. Demonstrates knowledge of the eligibility system and all various insurance websites/software. Excellent time management and organizational skills. Knowledge of Payer terminology and in depth authorization requirements specific by payers.

Knowledge of common Government programs, including California Children's Services
Technical Knowledge: Ability to successfully navigate insurance websites. EPIC experience required, ADT and Cadence referrals preferred. Basic knowledge of Microsoft Office Suite (Word, Excel).


Physical Requirements:

Sit:

Up to 8 hours/day Stand/Walk: 3-6 hours Bend/Stoop: Up to 3 hours Reach: Up to 3 hours Rep Use of UE/Grasp: Up to 8 hours Lift/Push/Pull: 15 lbs.

This job requires the ability to hear alarms clients and/or instruction. The ability to see accurately from 20 inches to 20-ft. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function of this position.