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Rochester Regional Health · 3 days ago

Finance and Authorization Specialist

Rochester, NY

Full-time

Onsite

Entry, Mid Level

$18/hr - $25/hr

2+ years exp

Rochester Regional Health is seeking a Finance and Authorization Specialist to manage insurance verification and authorization processes. The role involves ensuring accurate patient estimates, coordinating with various departments, and maintaining communication regarding insurance issues and authorizations.

Health CareHospitalMedicalPrimary and Urgent CareWellness

Responsibilities

Utilize appropriate insurance verification tools to validate patient insurance eligibility

Generate timely patient estimates through the use of Rochester Regional Health's Estimate Tool

Support internal offices with generating estimates for future services, as requested

Deliver Price Estimates to patients in a courteous and knowledgeable manner

Deliver finalized estimate findings to patient via phone call, email, or MyCare channels

Obtain prior-authorization on both internal and external department orders for procedures/treatments performed in the department; applicable to both new and established patients

Coordinate with Patient Registration to appropriately and accurately schedule patients in accordance with the provider's orders

Communicate with other departments to address scheduling or authorization issues

Complete forms and letters to insurance for visit coverage

Monitor daily schedules for add-on appointments, insurance changes, and work accordingly within our policies to verify insurance, process estimates, and/or obtain authorizations

Monitor pending authorizations and follow due process should it need to be rescheduled

Participate in orientation of new staff

Obtain referrals from payers that require it

Obtain insurance information through various searches when not in the system

Complete other duties as assigned

Obtain prior-authorization on internal department orders for medications administered at oncology infusion locations; applicable to both new and established patients

Review Oncology infusion orders for medical necessity per CMS, Manufacturer, or NCCN guidelines. Work with physicians if these specific guidelines are not met by documentation

Verify authorizations for non-oncology patients for whom we have received medication administration orders

Communication to Oncology pharmacy of insurer preferred brands for requested products

Assist with research and resolution of denials as requested

Qualification

Insurance verificationICD-10 codesCPT/HCPCS codesEMR softwareCustomer serviceComputer proficiencyCommunication skillsProblem solvingAttention to detail