JOB RESPONSIBILITIES
Pre-Authorization -Utilize systems including medical records to obtain needed clinical support to efficiently confirm receipt of or to obtain pre-authorization for scheduled services and medications that require a higher level of clinical knowledge. Collaborate with internal and external resources regarding specific authorizations scenarios and manages escalated issues and provides feedback to team members. Work with team to make contact with families prior to patient scheduled visits and/or services to confirm insurance eligibility, referrals/authorizations with minimal stress to the family/patient.
Problem Resolution -Serve as second level problem resolution for both internal and external customers, involving Manager, if necessary. Responsible for research, analysis and resolution of complex issues and questions. Identify patterns in questions and problem issues with staff and participate in determining and addressing root causes.
Collaboration -Serve as a liaison between Hospital/Physicians Billing Service, Admitting, Outpatient Surgery, Outpatient Department, Patient Financial Services, Utilization Review and other Cincinnati Children's departments. Multiple division support; cross trained in order to work insurance pre-authorization for multiple divisions. Participate in Department Meetings to share payer trends related to Pre-Authorizations.
Productivity -Work independently and/or collaboratively with team to efficiently handle work volume and queues to meet or exceed productivity standards. Accurately collect/verify insurance information and demographics, obtaining insurance authorization and entering the information into the required systems. Assign tasks to the appropriate skill level as needed to ensure efficiency and productivity.
Coordination -Serve as an internal and external resource/expert for health insurance questions from customers/clients. Act as a preceptor for new employees and provide instruction for performing non-routine functions for staff. Work collaboratively with team to establish and maintain payer specific coverage libraries and communicate/update payer information health system requirements utilizing departmental SharePoint or other resources. Working knowledge and functions of multiple divisions. Complete retrospective authorizations when necessary.
JOB QUALIFICATIONS
High school diploma or equivalent
3+ years of work experience in a related job discipline
Primary Location
South Campus
Schedule
Full time
Shift
Day (United States of America)
Department
Financial Clearance Center
Employee Status
Regular
FTE
1
Weekly Hours
40
*Expected Starting Pay Range
$22.18 - $27.73
About Us
At Cincinnati Children’s, we come to work with one goal: to make children’s health better. We believe in a holistic team approach, both in caring for patients and their families, and in advancing science and discovery. We strive to do better and find energy and inspiration in our shared purpose. If you want to be the best you can be, you can do it at Cincinnati Children’s.
Cincinnati Children's is:
Recognized by U.S. News & World Report as a top 10 best Children's Hospitals in the nation for more than 15 years
Consistently among the top 3 Children's Hospitals for National Institutes of Health (NIH) Funding
Recognized as one of America’s Best Large Employers (2025) , America’s Best Employers for New Grads (2025)
One of the nation's America’s Most Innovative Companies as noted by Fortune
Consistently certified as great place to work
A Leading Disability Employer as noted by the National Organization on Disability
Magnet® designated for the fourth consecutive time by the American Nurses Credentialing Center (ANCC)
We Embrace Innovation—Together. We believe in empowering our teams with the tools that help us work smarter and care better. That’s why we support the responsible use of artificial intelligence. By encouraging innovation, we’re creating space for new ideas, better outcomes, and a stronger future—for all of us.
Comprehensive job description provided upon request.
Cincinnati Children’s is proud to be an Equal Opportunity Employer committed to creating an environment of dignity and respect for all our employees, patients, and families. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, genetic information, national origin, sexual orientation, gender identity, disability or protected veteran status. EEO/Veteran/Disability
Cincinnati Children’s, a nonprofit academic medical center established in 1883, offers services from well-child care to treatment for the most rare and complex conditions. It is the Department of Pediatrics at the University of Cincinnati College of Medicine and trains more than 600 residents and clinical fellows each year. Cincinnati Children’s is a force in pediatric research and offers some of the best research-based education and training programs in the nation.
Cincinnati Children’s is proud to be an Equal Opportunity Employer committed to creating an environment of dignity and respect for all our employees, patients, and families. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, genetic information, national origin, sexual orientation, gender identity, disability or protected veteran status. EEO/Veteran/Disability
