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[Hiring] Prior Authorization Specialist @Nationwide Children's Hospital
This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.
Role Description
This role involves coordinating 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.
- 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.
Qualifications
- High School Diploma or equivalent, required.
- Two years of experience billing public and private insurers for medical services using computerized billing system, required.
- Homecare services experience, preferred.
Requirements
- OCCASIONALLY: Flexing/extending of neck, Lifting / Carrying: 0-10 lbs, Standing, Walking
- 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
- Talking on the phone / in person Frequently (34 - 66%)
