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Insurance Pre-Authorization Specialist

Company: Memorial Health System
Location: Springfield
Posted on: June 12, 2019

Job Description:

Status: Full Time

Hours: 8:00 a.m. - 4:30 p.m., including every other weekend

Basic Summary: Responsible for the completion of prior authorization, pre-certification, and notification for third party and government payers for all pre-scheduled elective inpatient, Direct Admits, Emergency Room Admits and outpatient procedures. Utilizes a thorough working knowledge of insurance plans and benefit structures to obtain detailed benefit information and maximize plan benefits. Coordinates with third party payers, physicians, nursing staff and other health care providers, providing education/direction around the prior authorization/pre-certification process and requirements to ensure all government and other payer requirements are met for accurate organizational reimbursement. Tracks, documents, and monitors prior authorization and pre-certification status. Performs dynamic coding of outpatient services and urgent admits, correlating and documenting accurate procedural and diagnosis codes with physician orders. Responsible for providing notification of delays or denials of pre-authorization/pre-certification approvals to clinical staff within various service lines, and to the Managed Care, Utilization Management, and Patient Financial Services units. May provide direction to patients on the appropriate appeal procedures for denials. Understands insurance/payer policy language, benefits and authorization requirements upon admission, during hospital stay, and discharge, including concurrent reviews while patient is being treated. Embodies the Memorial Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision and values.


  • High school diploma or equivalent required.

  • Three years of healthcare registration, billing/claims, scheduling, or Physicians office experience required.

  • Experience with and/or working knowledge of Call Center processes preferred.

    Required Skills

    Required Experience

    Job Location

    Springfield, US-IL

Keywords: Memorial Health System, Springfield , Insurance Pre-Authorization Specialist, Other , Springfield, Illinois

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