Patient Insurance Coordinator in Philadelphia, PA at Shriners Hospitals for Children

Date Posted: 10/3/2019

Job Snapshot

  • Employee Type:
  • Location:
    3551 North Broad Street
    Philadelphia, PA
  • Job Type:
  • Experience:
    At least 2 year(s)
  • Date Posted:

Job Description

The insurance Coordinator is primarily responsible for obtaining authorizations and referrals for all inpatients and outpatient appointments for physicians, therapists, and other ancillary services. Perform all registration tasks when updated information is obtained. Also responsible for assisting department manager with tasks that are essential for maintaining efficient daily functioning of the department.

 Verify Eligibility

• Verify insurance using the real-time integrated Cerner tool for participating payers.

• Verify insurance for all other payers utilizing their website or make a phone call.

• Flag patients with an invalid or inactive response to the Insurance Denied Work list and follow-up with patient/guardian to obtain additional information.

• Flag patients who do not have active coverage to the Uninsured Work list and perform related questionnaire.

• Flag patients needing an authorization or referral so they will populate the Incomplete Authorizations or the referral work lists.

•Work with CDI specialist and Physician extenders to facilitate peer to peer appeals for authorization.

• Update pre-registration of future visits to ensure all current demographic and insurance information captured         when new information is obtained.

 Obtain Referrals

• Monitor the Incomplete Referral Work list daily.

• Contact the patient's primary care physician to obtain authorization/referral number if unavailable on web portals.

• Enter number in system with start and end date and number of visits.

• Escalate account to supervisor if referral is not obtained 48 hours prior to visit.

• Update referral status to approved once complete to remove from work list.

 Obtain Authorization

• Monitor Incomplete Authorization Work list daily.

• Contact payer to obtain authorization number using website or phone call.

• Enter authorization information in system with accurate health plan comments.

• Escalate account to supervisor if authorization is not obtained 48 hours prior to visit.

• Update authorization status to appropriate status and follow up timely until final status is determined.

Other Duties as Assigned

** This is a part-time position and will require 20 hours per week**


Job Requirements

2 Years Insurance prior-authorization in a medical/surgical office and/or hospital setting- Preferred

Additional Experience

-Knowledge and experience with insurance verification, obtaining authorizations and referrals, and registration.

-Ability to work closely with multiple internal and external customers, including co-workers, physicians, therapist, nurses, and patients / families.

-Proficiency with basic computer skills, including Word and Excel.

-Bilingual (Spanish / English) speaking and writing skills are highly preferred.