As one of the nation’s leading pediatric health care systems, Nemours is committed to providing all children with their best chance to grow up healthy. We offer integrated, family-centered care to more than 300,000 children each year in our pediatric hospitals, specialty clinics and primary care practices in Delaware, Florida, Maryland, New Jersey and Pennsylvania. Nemours strives to ensure a healthier tomorrow for all children – even those who may never enter our doors – through our world-changing research, education and advocacy efforts. At Nemours, our Associates help us deliver on the promise we make to every family we have the privilege of serving: to treat their child as if they were our own.
The Authorization Specialist - Audiology is responsible for appointment scheduling, insurance authorization/estimates for both durable medical equipment and visits, and check in desk coverage including co-pay collection.
Responsible for accurate and complete patient accounts based on departmental protocol, policies and procedures, and compliance with regulatory agencies, to include but not limited to pre-registration and registration functions, timely and accurate appointment scheduling, check-in and co-pay collection. Ensure all insurance requirements are met prior to patients' arrival, and inform patients of their financial liability.
This position has high customer service interaction with our patients, payors and physicians by phone and in-person and requires excellent customer service and critical thinking skills.
Greets patients and families in person or by phone using AIDET. Maintains a friendly and welcoming atmosphere in a busy and public work environment. Maintains patient confidentiality. Pre-registration functions:
Collects and documents accurate patient demographics and insurance information.
Analyzes insurance coverage and benefits for service to ensure timely reimbursement.
Obtains all prior authorizations as appropriate based on insurance plan contracts / guidelines and documents in EPIC system per policy and procedure.
Obtains all durable medical authorizations for hearing aid, baha and cochlear implant equipment as needed.
Enters and updates referrals as required.
Communicate with insurance carriers regarding clinical information requested and to resolve issues relating to coverage and payment for specific patients and benefits.
Notifies families of insurance limitations or potential out of pocket costs for requested services via estimate letter in mail or phone for services estimated over $500.
Mails or emails intake questionnaires as appropriate; files intake information in patient’s chart.
Facilitates referral to Financial Services for payment sources for uninsured patients.
Collects any financial responsibility from family for durable medical equipment.
Schedules and assists with coordinating a variety of complex visit types and appointments for multiple disciplines and sites. Registration Functions (including but not limited to):
Requests picture ID 100% of the time during initial check-in of evaluation
Systematically collects consents and other required documents (real-time)
Verify insurance cards and other important documents (real-time)
Collects and posts co-pays, any past due balances, and reconciles money at the end of the shift, as required by program
Schedules follow-up appointments as needed
Achieve a daily “after visit” verification (insurance and demographics) percentage of => 95%
Alerts clinical staff of patient arrival and communicates with clinical staff as to the status of patients waiting more than 10 minutes after scheduled visit.
Accurately records status of therapy appointments, differentiating no-show versus cancellation etc
Handles triage of “walk down “appointments for scheduling and insurance approvals.
Works collaboratively with clinical staff, Central Business Office, financial counselors etc to assure coverage and payment are obtained for all services rendered. Identifies trends and alerts managers and supervisors to plan benefit changes that may affect services. Appropriately communicates with a variety of contacts (patients, parents, physician, clinicians, patient relations, translators etc). Must have ability to work well with others. Regular attendance required. Good communication skills are required both written and verbal. Staffing:
Takes staff sick calls and notifies Manager and/or Director.
Checks staff availability and assists Manager or designee with re-assignments.
Calls parents with schedule changes when necessary.
Prepares and prints daily schedules
High School diploma or equivalent required
Medical scheduling or insurance verification experience preferred;
Knowledge of insurance and coverage, scheduling experience preferred
Our dedication to professionals who are dedicated to children frequently earns Nemours a spot on the list of top workplaces in the communities we serve. Our Associates enjoy comprehensive benefits, including our unique “Bridge to a Healthy Future” pediatric health plan, an integrated wellness program, opportunities for professional growth, and much more. As an equal opportunity employer, Nemours focuses on the best-qualified applicants for our openings.
Nemours is committed to improving the health of children. As a non-profit children’s health organization, we consider the health of every child to be a sacred trust. Through family-centered care in our children’s hospitals and clinics in Delaware, New Jersey, Pennsylvania and Florida, as well as world-changing research, education and advocacy, Nemours fulfills the promise of a healthier tomorrow for all children — even those who may never enter our doors. Nemours began more than 70 years ago with the vision of Alfred I. duPont to improve the lives of children and to do whatever it takes to prevent and treat even the most disabling childhood conditions. Today, through our children’s hospitals and health system, we directly care for 250,000 children annually in Delaware Valley and Florida, including families who travel from across the country and world to see our specialists — treating every child as we would our own. We also reach beyond the walls of our hospitals and clinics to be a voice for children on a national and international level, and to lead the way in prevention, intervention, education, and research. Nemours is growing to better serve the children and families in our ca...re. We have 1.1 million square feet of space currently devoted to providing children’s healthcare or under construction, all designed with significant input and advice from our patients and families.