Insurance Authorization Coordinator - Outpatient Admin, Registry
Rehabilitation Institute of Chicago

Job Info

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General Summary
The Insurance Authorization Coordinator will determine eligibility for third party payer benefits and obtains initial financial authorization when required; including expediting response to referral inquiry, insuring benefits are available to cover, obtaining insurance authorization, assessing clinical information of referral and obtaining social and demographic information to support authorization or referral process. Notifies patient/family and clinical area if third party coverage will not reimburse any or all of the planned care. Identifies alternative payment options to the patient/family and refers appropriate cases to the Care Manager.

The Insurance Authorization Coordinator will consistently demonstrate support of the Shirley Ryan AbilityLab statement of Vision, Mission and Core Values by striving for excellence, contributing to the team efforts and showing respect and compassion for patients and their families, fellow employees, and all others with whom there is contact at or in the interest of the institute.

The Insurance Authorization Coordinator will demonstrate Shirley Ryan AbilityLab Core Attributes: Communication, Accountability, Flexibility/Adaptability, Judgment/Problem Solving, Customer Service and Core Values (Hope, Compassion, Discovery, Collaboration, & Commitment to Excellence) while fulfilling job duties.

Principal Responsibilities
The Insurance Authorization Coordinator:

1. Researches and verifies financial coverage with third-party payers for planned services prior to patient's scheduled appointment, which includes completing authorization requirements for the patient's specific plan and communicating limitations or denials to patient/family
2. Refers cases to outpatient Care Managers or Social Workers when patients are unable to pay for services or services are not covered under a third-party payer.
3. Documents receipt and forwards appropriate forms (such as a primary care physician referral or a signed agreement to self-pay) to Patient Financial Services.
4. Documents all financial clearance information in Information System.
5. Coordinates Clinic referral and authorization processes including expediting response to referral inquiry, insuring benefits are available, obtaining insurance authorization, assessing clinical information of referral and obtaining social and demographic information to support.
6. Screens, and responds to requests for general information regarding Shirley Ryan AbilityLab services and programs.
7. Identifies and verifies patient benefits and initiates the pre-certification process by accessing insurance company, Medicare, and/or Medicaid data bases.
8. Identifies and implements improvements to enhance efficiency and outcomes and to solve unique or complicated problems.
9. Updates demographic, insurance, funding and medical information in Shirley Ryan AbilityLab Information System, as needed.
10. Communicates information to the outpatient clinical team or Shirley Ryan AbilityLab inpatient Care Managers as needed.
11. Communicates all actual or potential denials to Financial Clearance Supervisor.
12. Performs all other duties that may be assigned in the best interest of Shirley Ryan AbilityLab.

Reporting Relationships
Reporting relationships will vary according to departmental structure

Knowledge, Skills & Abilities Required

1. Minimum educational requirements high school degree or equivalent, Associate College degree preferred.
2. Minimum of 2 years of experience normally acquired through prior insurance authorization or pre-certification exp. Knowledge of rehabilitation medicine preferred
3. Working knowledge of Windows operating environment and Microsoft Office software applications.
4. Strong customer service and interpersonal skills necessary to interact with all levels of Shirley Ryan AbilityLab personnel, physicians, insurance representatives, and other internal and external customers.
5. Analytical skills necessary to ensure complete, accurate and timely financial clearance is obtained for all outpatients receiving rehabilitation services at Shirley Ryan AbilityLab.
6. Proficiency in keyboarding skills. Application of a variety of a variety of moderately complex computer PC software

Working Conditions

1. Normal office environment with little or no exposure to dust or extreme temperature.

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.

Shirley Ryan AbilityLab is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.

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