Hospital Authorization Specialist II @ NemoursCareerSite

Nemours Children's Health is an internationally recognized pediatric health system serving more than 1.7 million patient encounters each year. We deliver care across six states through two freestanding children’s hospitals — Nemours Children's Hospital, Delaware and Nemours Children's Hospital, Florida — along with a network of more than 80 primary, urgent, and specialty care practices and more than 40 hospital partnerships.

Backed by the Nemours Foundation and Alfred I. duPont Trust, our $1.7B nonprofit system is dedicated to improving children's health through clinical care, research, education, advocacy, and prevention. Our Whole Child Health approach focuses equally on prevention and treatment, partnering with communities to help every child thrive.

Inclusion and belonging guide our strategy and growth. We are committed to culturally relevant care, reducing health disparities, and fostering an environment where every associate, patient, and family feels supported and valued.

Learn more at Nemours.org.

Join our team as a Hospital Authorization Specialist II!

The Hospital Authorization Specialist II is responsible for obtaining authorizations for hospital-based scheduled services but may also include physician-based appointments.

The Specialist will be assigned to a workqueue to initiate the authorization, follow-up, monitor add-ons, and update an authorization with changes to the original authorization request. The timeframe to complete an authorization for all scheduled services must be within department guidelines.

The Specialist will use all available resources to complete authorization requests and verify eligibility. The associate will need to fully understand how to interpret benefits when verifying eligibility in order to complete an estimate or when speaking to a patient or patient’s family. The Hospital Authorization Specialist II will assist with training on new processes.

This is a Remote position. Applicants must reside in one of the following states: Alabama, Colorado, Delaware, the District of Columbia, Florida, Georgia, Illinois, Maryland, Missouri, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia.

Essential Functions

• Ability to request and obtain preauthorization for assigned specialties and be able to cover for other specialties including workqueues, preadmissions (if applicable), and estimates.
• Ensure request for authorizations and notifications are worked timely and handled in accordance with departmental policy and payer requirements. Follow all documentation requirements.
• Understand the financial impact of services not authorized or incorrectly authorized.
• Utilize payer tools to determine if an authorization is required. Review payer’s clinical guidelines when necessary.
• Appointment or case add-ons, changes to previously scheduled services, date changes, and patient class changes will need an immediate review.
• Follow administrative review process if a case does not have an insurance authorization outside of the department’s standard timeframe.
• Promptly review clinical documentation for necessary information to submit to the payer along with authorization request.
• Accurately verify patient demographics, insurance eligibility, benefits, and financial responsibility.
• Clearly document all communications and contacts with payers, physicians, and families in standardized documentation requirements including proper format. Communicate effectively, timely and professionally in writing and verbally.
• Collaborates with the Central Business Office, Financial Services, Transport, Patient Cost Estimation, Managed Care, Utilization Review, Physician Authorization Department, and other departments that have impact on obtaining authorizations and/or reimbursement.
• The Specialist will attend and participate in daily departmental huddles to report on payer issues, barriers affecting workflows, and specific issues that could result in a non-reimbursable or canceled service.
• The Specialist must be organized, work effectively in a virtual team environment, can problem solve, and seek assistance when needed.
• Build and maintain professional, cooperative relationships with contacts from specialty departments. Consistently demonstrates excellent, empathetic, and knowledgeable customer service skills to internal and external customers. .

Qualifications

• Authorization experience required.
• High School Diploma required
• 1-3 years of job related experience required.
• Revenue Cycle related certification. Ie. CRCR preferred

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