BH Insurance/Precert SpecialistRequisition ID2023-47692CategoryBehavioral HealthOverviewThe BH Insurance/Precert Specialist is responsible for the verification of benefits, requesting initial authorization, documentation of benefit information, and meeting provider's referral requirements to ensure that optimum payment is made to the hospital and providers.Schedule: Monday - Friday 8:00am-4:30pm. This position will work fully in-person for the first 90 days of employment, then will transition to working from home.Location:Behavioral Health Pavilion444 Butterfly Gardens DriveColumbus, Ohio 43215Why Nationwide Children's Hospital?The moment you walk through our doors, you feel it. When you meet our patient families, you believe it. And when you talk with anyone who works here, you want to be part of it. Welcome to Nationwide Children's Hospital, Where Passion Meets Purpose.Here, Diversity, Equity and Inclusion are integrated into our core values and practices. We are passionate about building, sustaining and evolving an inclusive and equitable environment. We are seeking individuals who live these values and want to share their experiences and efforts in support of our collective mission.We're 14,000 strong. And it takes every one of us to improve the lives of the kids we care for, and the kids around the world we'll never meet. Kids who live healthier, fuller lives because of the knowledge we share. We know it takes a Collaborative Culture to deliver on our promise to provide the very best, innovative care and to foster new discoveries, made possible by the most groundbreaking research. Anywhere.Ask anyone with a Nationwide Children's badge what they do for a living. They'll tell you it's More Than a Job. It's a calling. It's a chance to use and grow your talent to make an impact that truly matters. Because here, we exist simply to help children everywhere.Nationwide Children's Hospital. A Place to Be Proud.ResponsibilitiesContacts insurance companies to obtain and verify benefit information, documents all benefit information, and meets payer's referral requirements to ensure that optimum payment to the hospital and providers will be satisfied.Obtains insurance prior authorization as needed and documents the verification of benefits and prior authorizations in Epic. Maintains record of pending prior authorizations and documents timely follow-up.Assists with the retrospective review of records for patients who have insurance changes that impact the authorization.Communicates authorization denials and appeal options to referral sources/Providers. Assists with coverage resources as appropriate.Contacts schedulers if insurance cannot be verified and refers self-pay patients to financial assistance resources.Participates in department and interdepartmental meetings to promote knowledge, troubleshoot, and resolve issues related to benefits or authorizations.Maintains knowledge of The Joint Commission, Medicaid, Medicare, and other third-party payer standards and requirements.Note: Regular, reliable and consistent attendance is an essential job function. Employees are expected to perform work as scheduled. Please see the physical requirements for this position listed below.QualificationsEducation: High school graduate, Associate's Degree preferred.Experience: One-year previous health care or insurance experience preferred.Skills: Strong computer skills required with the ability to navigate most current technology systems. Excellent written, communication, and organizational skills required.Certifications: CPR certification (based on position and as determined by manager).Minimum Physical Requirements