The Christ Hospital Health Network Insurance Authorization & Cost Estimate Specialist in CINCINNATI, Ohio

There are many ways to define excellence. For us at The Christ Hospital, it’s all about our patients...And making healthcare what they want it to be. Accessible. Personal. Affordable.

Our commitment to exceptional outcomes, affordable care and the finest patient experiences is recognized yearly with numerous awards from leading healthcare organizations and publications. At the top of our list of honors are the 17 consecutive years that we’ve been named to U.S. News & World Report’s list of Best Hospitals and being named the Most Preferred Hospital by the Greater Cincinnati community for 21 consecutive years (National Research Corporation).

What does this mean for you?

GROWTH- opportunities to learn, develop, and impact.

VALUE- a robust employee package that provides you the ability to maintain a healthy work-life balance, competitive compensation, flexible and meaningful benefits, development opportunities so you can be your best self, and a culture of compassion.

PRIDE- from all that we have accomplished in our past, and all that we’re positioned for in the future.

CHALLENGE- we are in one of the most competitive markets in the nation, yet continue to rise to the top through our incredible employees and transformational results. We seek individuals motivated by what it takes to be a part of a winning team.

Named #24 on Forbes 500 America’s Best Employers for 2017, we are transforming care…inspired by you.

Title: Insurance Authorization & Cost Estimate Specialist

Shift: Full-Time, Days

This position will be located in the Financial Clearance department at the Central Business Office located at 237 William Howard Taft Road, Cincinnati, Ohio 45219.

Job Overview: The Insurance Authorization & Cost Estimate Specialist is responsible for collecting necessary insurance benefit and clinical information to properly authorization the ordered service with the patient’s insurance company. This includes steps to support insurance and benefit verification, pre-certification, and pre-authorization processes.

  • The specialist must have clinical knowledge of services so appropriate information can be communicated/given to the insurance company which will ensure the service is rendered in the correct level of care. Reimbursement for the service rendered is dependent upon the insurance benefit verification process and meeting the authorization requirements of the insurance company.

  • The specialist must also determine when the patient is under-insured so that additional funding sources can be evaluated and applied.

  • Once authorized, the specialist determines the cost for the service by applying the patient benefits / coverage information and estimate functionality accessible through IT applications. This process is essential to ensuring the patient understands their financial responsibilities for the service rendered. This is a very dynamic environment as insurance plans, benefits, and coverage structures change frequently and the turnaround is essential so that treatment is not delayed.

  • This individual will need expert knowledge of insurance plans, insurance regulations, and insurance benefit and coverages as they relate to the service rendered. Additionally, this team serves as a point of contact within the organizations for questions and issues as they relate to insurance plans and coverage information.

  • The duties and responsibilities this individual performs is solely dependent on the organization receiving reimbursement for the service rendered and ensuring the patients cost are clearly identified.

The Insurance Authorization & Cost Estimate Specialist may perform the following duties:

Insurance Authorization

  • Utilizes online systems, phone communication, and other resources to verify eligibility and benefits, determine extent of coverage, secure pre-authorizations, and determine patient liabilities within a timeframe before scheduled appointments determined by The Christ Hospital Health Network and during or after care for unscheduled patients

  • Verifies medical necessity in accordance with the Centers for Medicare & Medicaid Services (CMS) standards, and communicates relevant coverage/eligibility information to the patient

  • Coordinates benefits by effectively determining primary, secondary, and tertiary liability when needed

  • Obtains pre-certifications and pre-authorizations from third-party payers in accordance with payer requirements

  • Provides collections team with personalized patient estimates of financial responsibility based on insurance coverage or eligibility for government programs

  • Remains updated on rates and changes to pricing/estimation system as necessary in order to ensure price estimates remain accurate

  • Alerts physician offices to issues with verifying insurance and/or obtaining pre-authorizations

  • Demonstrates understanding of insurance terminology (e.g., co-payments, deductibles, allowances, etc.), and analyzes information received to determine patients’ out-of-pocket liabilities

  • Connects patients with financial counselors when further explanation or education is needed or requested regarding payment plans or financial assistance; may conduct some basic financial counseling duties as necessary

Communication

  • Communicates with patients, physicians, clinicians, front-end staff, or translators to obtain missing patient demographic or insurance information

  • Communicates liabilities directly to patients and provides education on key insurance terms and rules; may often handle patients with more complicated insurance plans (e.g., workers’ compensation)

  • Maintains excellent relationships with physician’s offices, insurance companies and other hospital departments.

Estimates

  • Provides collections team with personalized patient estimates of financial responsibility based on insurance coverage or eligibility for government programs

  • Communicates liabilities directly to patients and provides education on key insurance terms and rules; may often handle patients with more complicated insurance plans (e.g., workers’ comp)

Education

  • Remains updated on payor requirements and rates and changes to pricing for estimates.

Education: High School Diploma or GED required. Associate or bachelor’s degree in healthcare administration or related preferred.

Experience: One to two years of registration or insurance verification related experience required.

Required Skills & Knowledge:

  • Excellent analytical skills required

  • Customer service experience required

  • General knowledge of the following:

  • EHR programs (e.g., Epic)

  • Medical terminology

  • CD-10, CPT, HCPCS codes, and coding processes

  • Knowledge of or experience with other front-end processes, including scheduling, pre-registration, financial counseling, and registration; understanding of the revenue cycle as a whole

  • Superb teamwork skills

  • Efficient time management skills and ability to multitask

  • Excellent writing, oral, and interpersonal communication skills

  • Strong understanding and comfort level with computer systems and payor regulations