Providence Health & Services Insurance Verification and Authorization Specialist in Oregon
Providence St. Joseph Health is calling an Insurance Verification and Authorization Specialist to work remotely within OR/WA.
We are seeking an Insurance Verification and Authorization Specialist to be responsible for securing appropriate patient account reimbursement by obtaining complex demographic, insurance, and medical information, identifying services requiring authorization for treatment and ensuring the required authorizations are in place.
In this position you will:
Reviews high volume of referrals proactively to secure payment and provide customer service prior to the patient's date of service.
Confirms eligibility and benefit information from third party payors to secure sponsorship of patient accounts.
Ensures authorizations or referrals for services provided are obtained and documented within required timeframes as designated by contract or third party payors.
Identifies and refers any accounts with unsecured sponsorship or limited benefits to Financial Counselors.
Secures payment for scheduled or unscheduled services and provides customer service to the patient.
Interacts with physician's office, insurance company, and patient to resolve eligibility and coverage problems.
Collects patient co-payments, where appropriate, ensuring accurate documentation of all activity in the computer system. Notifies insurance plan of patient's arrival when necessary.
Documents work activity completely, concisely, and timely, according to standards in the computer, using Standard and Freeform notes.
Ensures compliance guidelines are followed for all Federal, State and other regulatory agencies, which include, but are not limited to, CMS, JCAHO, EMTALA, COBRA, and HIPAA
Required qualifications for this position include:
Knowledge of medical terminology obtained through college coursework or equivalent educcation/experience.
1 year experience in customer service or healthcare registration.
Healthcare experience, in either a provider or payor site.
Experience with State, Federal and other regulatory Compliance Regulations, including: Medicare Secondary Payor, EMTALA, and ABN.
Preferred qualifications for this position include:
2 years college education.
Satisfactory completion of college level Medical Terminology or Medical Assistant course.
Registrar, verification or third party payor experience.
National Certification of CHAA.
Knowledge of insurance and managed care payors.
About the department you will serve.
One Revenue Cycle (ORC) is the name adopted to reflect the Providence employees who work throughout Providence in revenue cycle systems and structures in support of our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. ORC’s objective is to ensure our core strategy, One Ministry Committed to Excellence, is delivered along with the enhanced overall patient care experience (know me, care for me, ease my way) by providing a robust foundation of services, operational and technical support, and the sharing of comprehensive, relevant, and highly specialized revenue cycle expertise.
We offer a full comprehensive range of benefits — see our website for details —http://www.providenceiscalling.jobs/rewards-benefits
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Patient Services
Other Location(s): Oregon
Req ID: 328770