Job Description

Fresno Surgical Hospital is an extraordinary hospital created entirely to deliver excellence and quality in surgical care to each patient. Our unique facility and staff provide a hospitality- inspired, healing environment unlike anything experienced in a traditional hospital. Our commitment to innovation, shared values, and excellence can be reflected in exceptional satisfaction scores from patients, physicians, and staff.

Job Summary

Utilizing the telephone and appropriate Internet applications, the Insurance Authorization is responsible for understanding of authorization requirements and medical policies for all patients of Fresno Surgical Hospital. Using independent judgment, this individual protects the facility by way of their knowledge of Fresno Surgical Hospitals contracted and non-contracted payors. Acts as liaison with patients, physician offices and internal departments. Responsible for confirming or obtaining authorization for medical services.

Reasonable Accommodation

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the position without compromising patient care.

Required Skills

Education and Experience

• High School Diploma or equivalent
• Previous billing experience preferred.
• Three years of related experience in credit and/or collections for a healthcare facility preferred

Required Skills

• Must be familiar with healthcare industry concepts, practices, and procedures.
• Thorough understanding of different insurance plans, government agencies, Medicare and Medicaid.
• Ability to maintain collaborative working relationships to ensure a positive and productive work environment.
• Ability to provide exceptional customer service.
• Basic computer knowledge.
• Correct and safe operation of office equipment, i.e., copy machine, adding machine, fax.
• PC competency, working knowledge of Microsoft Office Products (Word/Excel)

Required Experience

Essential Functions

Authorization Information/Procedures:

• Consults with internal and external entities to obtain and/or verify authorization information.
• Ensures accounts are financially secure by review of benefits, authorization/pre-certification requirements.
• Analyzes authorization information to ensure accuracy of required elements prior to patient’s date of surgery.
• Keeps abreast with insurance contracts to include prior authorization requirements and medical policies.

Authorization Standard Procedure:

• Verifies authorization information utilizing the IP/OP schedule list.
• Monitors and addresses procedure add-on and cancellation e-mails.
• Accurately updates Patient demographic information and ensures documentation standards are followed.

Professional Interaction/Patients:

• Acts as primary contact for internal and external entities assisting with insurance questions, i.e., benefits, covered vs. non-covered services, self-pay and patient estimation quotes based on out of pocket, deductible, coinsurance, etc.
• Contacts patients and clearly relays benefit, eligibility and approximate patient responsibility when estimation is $250.00 or greater.
• Promptly returns calls for messages received

Trends, Denials, Improvements:

• Assists department/ hospital in carrying out new procedures and processes with office staff, communicating effectively regarding pending authorizations (cut off time 3PM).
• Initiate retro-authorization when necessary, provide support to the hospital in managing and reducing denials.

Multitasks/Duties:

• Other duties as assigned

Salary range

$25.00 - $28.00 (Depending on Experience)

Benefits

Comprehensive Benefit Package-Medical, Dental, Vision, Life, Voluntary Life, Flexible Spending Accounts and 401 K.

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