INSURANCE VERIFICATION SPECIALIST

INSURANCE VERIFICATION SPECIALIST  

JOB SUMMARY

Authorization Specialists work on site at Mt. Washington Pediatric Hospital’s Baltimore location to verify insurance eligibility, benefits and coordinate the approval of care for our outpatient families here at MWPH at our Rogers Avenue and Capital Region locations.

ESSENTIAL FUNCTIONS OF POSITION

• Confirming outpatient appointment schedules daily.

• Verifies insurance eligibility, benefits, pre-certifications, prior authorizations and referrals requirements for scheduled outpatient services via telephone and/or insurance websites.

• Obtains any required pre-certifications, prior authorizations and referrals from insurance companies, primary care physicians and families.

• Documenting all appointment details in the department’s registration and electronic medical record keeping systems accurately including linking all referrals and authorizations to appointments accurately.

• Notifying families via phone or mail of any financial responsibilities prior to appointments including any non-covered services, deductibles, copays, and coinsurance amounts.

• Establishing payment arrangements and directing families to Financial Assistance programs when needed.

• Utilizing the ability to multitask, prioritize and self-motivate to achieve set team and department goals.

• Other duties as assigned.  

POSITION REQUIREMENTS

• High School Diploma/ Equivalent preferred.

• 3 years of experience in the insurance or health care field required.

• Familiar with the use of a personal computer and other essential office equipment including email software, printer, scanner, copier, fax machine and office telephone required.

• Basic insurance and manage care structure knowledge required.

• General medical terminology, CPT and ICD-10 coding knowledge required.

• Familiar with hospital electronic medical records systems such as Meditech required.

• Effective verbal and written communication skills required

• The ability to multi-task, prioritize and self-motivate daily.

• The ability to walk, sit, lift and stand for extended periods of time.  

REPORTING RELATIONSHIPS

• Supervision Received Manager Outpatient Prior Authorization Department

• Supervision Exercised None INTERPERSONAL RELATIONSHIPS

• Regular direct contact with families, physicians, insurance representatives, case managers, social workers and other hospital clinical staff.  

TOOLS/EQUIPMENT USED

• Personal computer, photocopier, fax machine, scanner, multi-line telephone  

PHYSICAL ENVIRONMENT/WORKING CONDITIONS

• General office setting within a health care facility.

• Minimal risk of exposure to body fluids, infectious waste or blood-borne diseases. Pace of working environment is accelerated due to multiple demands, phone volume and time constraints.

• This position has limited telecommuting opportunity.  

**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 11/09/2023    Revised 12/18/19