ADMISSIONS AUTHORIZATION SPECIALIST

JOB SUMMARY

The Admissions Authorization Specialist is responsible for assisting in the completion of tasks and assignments related to facilitating the admission process.  Including but not limited to processing requests for insurance verifications and authorizations using website portals and outbound phone calls for all insurance payers prior to admitting to Mt. Washington Pediatric Hospital (MWPH).  

ESSENTIAL FUNCTIONS OF POSITION

• Excellent knowledge of healthcare industry in regard to the revenue cycle, coding, claims and generally accepted insurance benefit terms and processes.
• Working knowledge of medical terminology, medical insurance and medical billing
• Obtains and/or reviews patient insurance information and eligibility verification to obtain authorizations for admission to MWPH.
• Knowledge of the processes to perform reviews and attain payment status for state insurance carriers utilizing telephone and internet
• Accurately delegates proper CPT and ICD-9/10 codes to ensure payments and approvals
• Provides insurance company with clinical information necessary to secure authorization and approvals
• Copying, faxing, filing, computer entry of admission data, assisting in 3808/1288 form completions
• Maintenance of admission and financial files as well as ensuring a clean well supplied and functioning environment.
• Provides relief coverage for other clerical aspects within the department.
• Participate in performance improvement initiatives, data tracking and collection for analysis.
• Functions with a focus on customer service.
• Handles phones, messages and mail in a timely manner.
• Consistently maintains timely and accurate documentation in the Medical Record as well as communication with the necessary parties regarding authorization activity related to each case.
• Completing Face to Face interviews with families of new admits to complete all required Admission/Payment documentation.(This will occasionally require the usage of translators in person or via electronic device.)
• Daily reporting of insurance authorization processing time, per insurance carrier, via workable system spreadsheet.
• When required, submitting insurance authorization request for retro services provided.

POSITION REQUIREMENTS

Educational Requirements

• High School Diploma/Equivalent preferred.

Knowledge, Skills and Abilities

• Minimum one-year experience as a Receptionist in a hospital or applicable clinical setting.
• Experience with hospital admission process, billing.
• Demonstrates excellent customer service skills.
• Highly effective interpersonal skills necessary to communicate effectively verbally and in writing
• Knowledge of medical and pharmaceutical terminology
• Display of sensitivity, compassion and tactfulness in dealing with internal and external customers
• Excellent time management and follow-up skills
• Detail oriented and ability to handle multiple tasks in an effective and efficient manner
• Ability to walk, run, stand, sit, reach, stoop, bend, rush, pull, demonstrate manual dexterity and mobility and has visual and auditory ability to do this job
• Knowledge in CPT and ICD9/10 codes.

REPORTING RELATIONSHIPS

Supervision Received

Reports to the Admissions Manager

Supervision Exercised

None

INTERPERSONAL RELATIONSHIPS

• Communicates daily in person or by telephone in a professional manner with internal and external customers.

TOOLS/EQUIPMENT USED

• Computer hardware and software, fax, copy machine, and other office equipment to support the job requirements.

PHYSICAL ENVIRONMENT/WORKING CONDITIONS

• Frequent stress due to multiple demands, shifting priorities, and tight time frames. Little or no risk of exposure to body fluids, infectious waste or blood borne disease.

This job description identifies the general nature and level of work to be performed. It is not to be considered an exhaustive list of responsibilities, duties or skills required of an incumbent.

Revised 01/14/2025