Pre-Authorization Specialist - (Omaha, Nebraska, United States)

Business: Boys Town National Research Hospital

Job Summary: In a career as a Pre-Authorization Specialist is responsible for pre-registration of hospital surgical and ancillary services. Primary functions include: insurance eligibility verification, benefit and out of pocket liability determinations, pre-determination and pre-certification / authorization of surgeries and/or other clinical services performed at BTNRH, or on behalf of a BTNRH provider. Provide our customers in a professional manner while working to exceed customer service expectations.

Schedule: 8:30am to 5:00pm (Full Time). Monday - Friday.

Responsibilities:
• 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.
• Meets productivity and quality standards, following all documentation guidelines as communicated by leadership.
• 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.
Required Qualifications:
• High school diploma or equivalent.
• Minimum of 2 years' experience working in a hospital or clinic billing environment, preferably focused on registration, billing and/or preauthorization, preferred.
• Knowledge of insurance terms and reimbursement procedures.
• Must be detail oriented.
• Knowledge of Explanation of Benefits (EOB), preferred.
• Excellent verbal and written communication skills required.
• Excellent telephone etiquette.

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. Unique perks to Boys Town employees and their families include free visits to Boys Town physicians and free prescriptions under the Boys Town Medical Plan, tuition assistance, 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.

Date Posted: November 29, 2021

Boys Town National Research Hospital is a tobacco free campus. 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-.