Hospital Authorization Specialist

Nemours is seeking a Hospitalization Authorization Specialist I, FULL-TIME, to join our Nemours Children's Hospital team in Orlando, Florida.

Located in Orlando, Fla., Nemours Children's Hospital is the newest addition to the Nemours integrated healthcare system.

Our 100-bed pediatric hospital also features the area's only 24-hour Emergency Department designed just for kids as well as outpatient pediatric clinics including several specialties previously unavailable in the region.

A hospital designed by families for families, Nemours Children's Hospital blends the healing power of nature with the latest in healthcare innovation to deliver world-class care to the children of Central Florida and beyond.

In keeping with our goal of bringing Nemours care into the communities we serve; we also provide specialty outpatient care in several clinics located throughout the region.

The Specialist is responsible for obtaining and processing Elective, Urgent, and Emergent authorizations for all surgical and non-surgical admissions including patient estimate creation.

Elective authorizations are obtained within 16 days prior to the admission / service date according to department standard and Emergent / Urgent notifications are to be initiated at the time of admission.

During the authorization and notification process the Specialist will provide the payor with all patient information and requested documentation necessary to obtain admission approval.

This role is required to utilize all available resources to verify eligibility, benefit levels. This position collaborates with : Utilization Management, Patient Access Staff, Patient Flow Supervisors, Clinical staff, Physicians, Surgery Schedulers and OR Team to ensure that accurate information is collected and distributed effectively and efficiently.

The Specialist utilizes daily reports and workqueues to complete follow up on non-approved cases and assure completion prior to admission date according to department standards.

In addition, the Specialist will attend daily departmental huddles to report on payor issues, barriers impacting workflows, and specific issues that could result in a non-reimbursable visit.

The Specialist is required to provide excellent, customer focused and efficient service to both internal and external customers and represent Nemours in a positive, professional manner.

This position is responsible for the following :

• Ensure timely request for authorization is handled in accordance with departmental policy and payor requirements.
• Maintaining confidentiality, verify patient demographics, insurance eligibility, benefits, and financial responsibility.
• Ability of request / obtain preauthorization for assigned specialties and be able to cover for most specialties and conversions.
• Effectively communicate with families; when appropriate.
• Collaborate with Surgery Scheduling and Financial Advocacy departments for any insurance related issues that may prevent obtaining an authorization.
• Clearly document all communications and contacts with payors and families in standardized documentation requirements including proper format.
• Record authorization information for all types of authorizations, complete standardized documentation requirements in expected format.
• Consistently demonstrates excellent, empathetic and knowledgeable customer service skills to internal and external customers.

Required Skills

• Communicate effectively, timely and professionally in writing and verbally.
• Knowledge of insurance plans and third-party payor requirements.
• Understanding of CPT, ICD 10 codes, MS-DRG and medical terminology.
• Willingness to achieve goals, accept feedback, and make constructive suggestions.
• Utilize Nemours Standards of Behavior and record as appropriate in Performance Management tool.
• Ability to organize and set priorities.
• Proficiency in the use of EMR system.
• Knowledge of, but not limited to, Microsoft Word, Excel and Outlook.

Job Requirements

• High School Diploma required. Specialized (1 year of training beyond high school).
• Minimum 6 months Hospitalization Authorization experience required. 1 year of experience preferred.
30+ days ago