<p>Key Responsibilities:</p> <ul> <li>Contacts insurance companies through online portal, phone or fax or to initiate authorization, obtain insurance benefits, eligibility, medical necessity, and / or authorization information. Updates Stamford Health systems with accurate information obtained. Responsible for communicating to service line partners of situations where rescheduling is necessary due to lack of authorization and / or limited benefits and is approved by clinical personnel based on defined service level agreements. </li><li>Validates scheduled procedures pass medical necessity verification where appropriate and notifies where Advanced Beneficiary Notices (ABNs) must be gathered from patients in advance if the supplied diagnoses information fails. </li><li>Meets or exceeds productivity standard and audit accuracy goals determined by Revenue Cycle Leadership, meeting timeline standards established by Leadership for all patient services. Ensures integrity of patient accounts by working error reports as requested by Management and/or entering appropriate and accurate data. </li><li>Proactively ensures that obtained benefits, authorizations, and/or pre-certifications are accurate according to the actual test / procedure or registration being performed. Confirms all benefits, medical necessity, authorizations, pre-certifications, and financial obligations of patients, are documented on account notes, clearly, accurately, precise, and detailed to ensure expeditious processing of patient accounts for hand-off to Pre-Service Representatives for estimate completion and patient contact to finish pre-registration. </li><li>Maintains a close working relationship with clinical partners and/or ancillary departments to ensure continual open communication between clinical, ancillary and all Revenue Cycle departments. May contact physicians or their staff to facilitate the sending of clinical information in support of the authorization to the payor, as assigned. </li><li>Monitors team mailbox and/or e-mail inbox, faxes, and/or phone calls, responding to all related Financial Clearance account issues, within defined time frames. Exhibits effective time management skills and maintains flexibility by being available for all partners and team. May assists team with reports and projects to maintain team and individual productivity standards and goals. </li><li>In working patient accounts for benefits, monitors accounts for change in insurance status prior to registration and sends updates to appropriate areas for follow up. In working patient accounts for pre-certification, contacts physicians or their staff, schedulers, and clinical service area where appropriate, notifying authorization is not obtained by department deadline, advising of visit cancellation, reschedule, or to obtain life or limb / urgent / emergent order from physician allowing patient to proceed in accordance with defined service level agreements. Contacts patient to notify when visit is rescheduled. </li><li>Maintains a current and thorough knowledge of utilizing online and system tools available, working from manual reports during system downtime. Maintains sign-on access to online tools to provide consistent service to patients, clinical partners, schedulers, and Front-End Revenue Cycle Operations team members. </li><li>Adheres to HIPAA regulations by verifying pertinent information to determine caller authorization level receiving information on account </li><li>Responsible for financial clearance on multiple service areas (Surgery, Inpatient, Cardiology, etc.) depending on operational needs </li><li>Other duties as assigned </li></ul> <p>QUALIFICATIONS:</p> <ul> <li>Ability to use discretion when discussing personnel/patient related issues that are confidential in nature </li><li>Responsive to ever-changing matrix of hospital needs and acts accordingly </li><li>Self-motivator, quick thinker </li><li>Capable of communicating professionally and effectively in English, both verbally and in writing </li></ul> <p>REQUIREMENTS:</p> <p>Prior experience obtaining prior authorization / pre-certification for scheduled services is required. Experience with managed care payers is required.</p> <p>EDUCATION:</p> <p>High School diploma or GED. Associate degree and/or higher-level education or completed coursework preferred.</p> <p>SKILLS:</p> <ul> <li>Proficient in Microsoft Office Programs such as Outlook, Word, and Excel </li><li>Proficient in performance of basic math functions </li></ul>