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HonorHealth offers a diverse benefits portfolio for our full-time and part-time team members designed to help you and your family live your best lives. Visit honorhealth.com/benefits to learn more.
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HonorHealth is one of Arizona’s largest nonprofit healthcare systems, serving a population of five million people in the greater Phoenix metropolitan area. The comprehensive network encompasses six acute-care hospitals, an extensive medical group with primary, specialty and urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization, community services and more. With nearly 15,000 team members, 3,700 affiliated providers and close to 2,000 volunteers dedicated to providing high quality care, HonorHealth strives to go beyond the expectations of a traditional healthcare system to improve the health and well-being of communities across Arizona. Learn more at HonorHealth.com.
Responsibilities
Job Summary
Under Pre-Services/Pre-Registration Leadership, this position performs financial clearance functions for hospital ancillary outpatient appointments. The position is responsible for denial prevention and protecting and contributing to the organization's financial goals by obtaining and documenting patients' insurance benefits and eligibility status, initiating and securing prior authorization with payers, and by validating, analyzing, and accurately interpreting medical necessity results by reviewing payer specific medical policies or criteria, utilizing the web-based medical necessity software. The position is responsible to create Commercial Waivers and Medicare ABN's, when necessary, and contacts patients to inform them of their insurance benefits and authorization status applicable to their scheduled service(s), or to discuss any issues with eligibility, medical necessity, or prior authorization. The position works closely with referring physician offices and the hospital departments where patient is scheduled, to minimize denials and insure authorizations are obtained in a timely manner. Detailed, accurate, and timely documentation of applicable insurance benefits, eligibility, prior authorization, interactions, and other payer or patient information into patients' EMR is required according to department standards. This is a work-from-home position that may require staff to commute to NSSC for staff meetings, staff training, and occasional one-on-one meetings with Supervisor. Occasional overtime work may be required.
- Performs tasks related to the management of prior authorization, insurance eligibility and benefits, and medical necessity for patients served by hospital ancillary departments. Obtains insurance eligibility and benefits utilizing Real Time Eligibility (RTE), payor websites, or when necessary, calling payor. Reviews payer specific medical policies/criteria when necessary to interpret medical necessity results using the web-based medical necessity tool. When necessary, reviews and/or requests clinical documentation from referring physician, to substantiate medical necessity and submis to payor with request for prior authorization.
- Requests and secures prior authorization for scheduled ancillary services and validates and interprets medical necessity prior to date of service and according to department standards.
- Provides results of benefits, eligibilty, prior authorization, and medical necessity to patients, applicable hospital ancillary department staff, and/or referring physicians, when needed, requested, or required.
- Answers in-bound and conducts out-bound calls from/to patients, referromg physicians' offices, and insurance plans, ancillary departments, and other individuals regarding an HonorHealth patient, or related inquiries.
- Quickly and professionally responds to concerns from patients, staff, and others involved in patient's care while maintaining a respectful demeanor.
- Adheres to all HonorHealth, Pre-Services and Patient Access policies and procedures.
- Communicates clearly, effecively, and respectfully in all interactions. Strictly adheres to the HonorHealth ICARE values and the Employee Standards of Conduct.
- Timely documents all new or updated patient and insurance plan information obtained into EMR according to department standards. Documents all interactions and information regarding patients' scheduled appointments, benefits, eligibility, and prior authorization in EMR according to department standards.
- Facilitates problem-solving with ancillary departments, providers, referral soures, or patients, as needed. Assists in the maintenance, communication, and documentation of changing/updating payor information specific to coordinaton of patient needs, prior authorization, benefits, and medical necessity.
Qualifications
Education
High School Diploma or GED Required
Experience
1 year in healthcare field: including medical office, insurance/front desk, medical insurance prior authorization, hospital registration, ancillary or surgical procedure scheduling, hospital business office (billing or collections), or prior experience in medical insurance company provider services or prior authorization departments. Required
Basic knowledge of health insurance plans and requirements; knowledge of hospital outpatient departments and services offered. Required
Type a minimum of 45 words-per-minute Required
