Job Description

About Us

We are Emerus, the leader in small-format hospitals. We partner with respected and like-minded health systems who share our mission: To provide the care patients need, in the neighborhoods they live, by teams they trust. Our growing number of amazing partners includes Allegheny Health Network, Ascension, Baptist Health System, Baylor Scott & White Health, ChristianaCare, Dignity Health St. Rose Dominican, The Hospitals of Providence, INTEGRIS Health, MultiCare and WellSpan. Our innovative hospitals are fully accredited and provide highly individualized care. Emerus' commitment to patient care extends far beyond the confines of societal norms. We believe that every individual who walks through our doors deserves compassionate, comprehensive care, regardless of their background, identity, or circumstances. We are committed to fostering a work environment focused on teamwork that celebrates diversity, promotes equity and ensures equal access to information, development and opportunity for all of our Healthcare Pros.

The purpose of this position is to obtain the necessary insurance authorizations for health services provided by the company.

Essential Job Functions

• Complete daily authorization requirements from all hospitalizations
• Reviews admissions for accuracy of insurance, coordination of benefits, and status
• Obtains clinicals, diagnosis information and ICD10 codes as necessary for completing the insurance authorization process
• Ensures insurance carrier documentation requirements are met and authorization documentation is scanned and documented in the patient’s record.
• Review and submit all follow-up requirements for further days certified.
• Works closely with Patient Access and the Billing Department on account updates and authorization activity.
• Works with Case Management on all denials and/or peer to peer reviews
• Maintains a good working knowledge of authorization requirements for all payors and state/federal regulatory guidelines for coverage and authorization of services provided.
• All of tasks as assigned.

Basic Qualifications

• High School Diploma or GED required
• Two years insurance verification and/or authorization experience required
• Expert knowledge of various payers and payer insurance cards required
• Knowledge of Microsoft Office Tools (Microsoft Word, Excel and Outlook), required
• Position requires fluency in English; written and oral communication