Authorization Specialist – Audiology at Nemours in Wilmington, Delaware

Job Description:

Audiology Speciality Care is in search of motivated associate who wants to be part of a dynamic team of Audiologist, Authorization Specialist and Technicians to serve a diverse group of patients with hearing and balance concerns as an Authorization Specialist.

Work hours: This is a 40 hour/week position. Mon. through Fri. 8:30 am to 5:00 pm.

Primary Responsibilities:

• Greets patients and families in person or by phone using AIDET. Maintains a friendly and welcoming atmosphere in a busy and public work environment. Maintains patient confidentiality.
• Pre-registration functions:
• Collects and documents accurate patient demographics and insurance information.
• Analyzes insurance coverage and benefits for service to ensure timely reimbursement.
• Obtains all prior authorizations as appropriate based on insurance plan contracts / guidelines and documents in EPIC system per policy and procedure.
• Enters and updates referrals as required.
• Communicate with insurance carriers regarding clinical information requested and to resolve issues relating to coverage and payment for specific patients and benefits.
• Notifies families of insurance limitations or potential out of pocket costs for requested services.
• Facilitates referral to Financial Services for payment sources for uninsured patients.
• Schedules and assists with coordinating appointments for multiple disciplines and with outside vendors as appropriate by program. Registration Functions (including but not limited to):
• Requests picture ID 100% of the time during initial check-in of evaluation
• Systematically collects consents and other required documents (real-time)
• Verify insurance cards and other important documents (real-time)
• Collects and posts co-pays, any past due balances, and reconciles money at the end of the shift, as required by program
• Schedules follow-up appointments as needed
• Achieve a daily "after visit" verification (insurance and demographics) percentage of => 95%
• Alerts clinical staff of patient arrival and communicates with clinical staff as to the status of patients waiting more than 10 minutes after scheduled visit.
• Accurately records status of therapy appointments, differentiating no-show versus cancellation etc...
• Works collaboratively with clinical staff, Central Business Office, financial counselors etc to assure coverage and payment are obtained for all services rendered.
• Identifies trends and alerts managers and supervisors to plan benefit changes that may affect services.
• Appropriately communicates with a variety of contacts (patients, parents, physician, clinicians, patient relations, translators etc).
• Must have ability to work well with others.
• Regular attendance required.
• Good communication skills are required both written and verbal.
• Verify insurance benefits for Dural Medical Equipment (DME), update teamshare with appropriate DME information, notify clinical staff of any issues with DME benefit, and inform families of any (OOP) out of pocket expenses.

• Must be a graduate of high school required, college degree preferred
• Excellent customer service skills in a fast paced changing environment.
• This position provides a high customer service to our patients, payors and physicians by phone
• EPIC experience preferred