Pre-Authorization Specialist

• Maintains excellent communication and positive rapport with all points of contact both internally and externally, documenting pertinent discussions and details of correspondence in all applicable systems to provide tracking and point of reference.
• Responsible for obtaining and communicating accurate benefit information and eligibility, pre-determination/pre-authorization as well as detailed benefit and patient liabilities per insurance company requirements and established timeframes, i.e., online vs. telephone to ensure credible coverage and benefits are in place.
• Responsible for monitoring incoming additions, revisions and cancellations as well as clinical requests for authorization and benefit identification. Practice includes; printing scheduled procedures from the Surgery Information System, assigning self to work case and identifying any need to contact patient to obtain additional registration or demographic information, as well as determining any change to authorization and/or coverage requirements.
• Routinely monitors cases pending or not yet started/complete which are a minimum of 1 month (4 weeks) out from scheduled date of service and initiates authorization/determination/eligibility process being attentive to payer specific processing time frames or clinical documentation needs.
• Obtains the necessary CPT, HCPC and Diagnosis codes as needed through utilization of coding resource materials, or through Supervisor or Coding Department assistance. When Codes are provided through community Provider office, will validate agreement of codes through internal practice and work with servicing provider to address any variance in findings.
• Initiates expedited reviews with payers when necessary to ensure authorization is in place prior to, or at the time of service and communicates late notifications or risk of no auth situations to Supervisor as soon as identified.
• Identifies and takes steps to ascertain and provide necessary clinical documentation to meet payer requests as needed for authorization or pre-determination needs.
• Responsible for data entry of documentation on patient accounts in the computer system, including completion of a surgery admission packet, financial disclosure and necessary admission forms.
• Communicates in a positive and professional manner with the patient / guarantor on any financial issues, including assisting with Financial Assistance application or referrals, accepting of required down payments and setting up acceptable payment plan agreements.

• Knowledge of insurance terms, reimbursement procedures, rates and policies related to medical terminology.
• Ability to give attention to detail and follow established standards and procedures.
• Knowledge of Explanation of Benefits (EOB), CPT, HCPC and Diagnosis Codes.
• Must have excellent verbal/ written communication skills to communicate effectively with physicians, patients and families.
• Knowledge of telephone etiquette required.
• Ability to handle multiple tasks at a time.
• Detail oriented.
• Knowledge of insurance terms and reimbursement procedures.

• High school diploma or equivalent required.

• Minimum of 2 years' experience working in a hospital or clinic billing environment, preferably focused on registration, billing and/or preauthorization preferred.

• Other Duties: This job description incorporates the essential functions and duties required for this position. However, other duties may be required and assigned at times and as determined by a supervisor in order to meet the needs of the organization.

• Serves as a role model in carrying out activities and behaviors that reflect the values and principles of the Boys Town mission.

• Position is relatively sedentary in a normal office administrative environment involving minimum exposure to physical risks. Will use office equipment such as a computer/laptop, monitor, keyboard, and a general workstation set-up.

Care and respect for others is more than a commitment at Boys Town - it is the foundation of who we are and what we do.

At Boys Town, we cultivate a culture of belonging for all employees that respects their individual strengths, views, and experiences. We believe that our differences enable us to be a better team - one that makes better decisions, drives innovation, and delivers better business results.

About Boys Town:

Boys Town has been changing the way America cares for children and families since 1917. With over a century of service, our employees have helped us grow from a small boardinghouse in downtown Omaha, Nebraska, into one of the largest national child and family care organizations in the country. With the addition of Boys Town National Research Hospital in 1977, our services branched out into the health care and research fields, offering even more career opportunities to those looking to make a real difference.

Our employees are our #1 supporters when it comes to achieving Boys Town's mission, which is why we are proud of their commitment to making the world a better place for children, families, patients, and communities. A unique feature for employees and their dependents enrolled in medical benefits are reduced to no cost visits for services performed by a Boys Town provider at a Boys Town location. Additional costs savings for the employee and their dependents are found in our pharmacy benefits with low to zero-dollar co-pays on certain maintenance drugs. Boys Town takes your mental health seriously with no cost mental health visits to an in-network provider. We help our employees prepare for retirement with a generous match on their 401K or 401K Roth account. Additional benefits include tuition reimbursement, parenting resources from our experts and professional development opportunities within the organization, just to name a few. Working at Boys Town is more than just a job, it is a way of life.

This advertisement describes the general nature of work to be performed and does not include an exhaustive list of all duties, skills, or abilities required. Boys Town is an equal employment opportunity employer and participates in the E-Verify program. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and/or expression, national origin, age, disability, or veteran status. To request a disability-related accommodation in the application process, contact us at 1-877-639-6003.