As one of the nation’s leading pediatric health care systems, Nemours is committed to providing all children with their best chance to grow up healthy. We offer integrated, family-centered care to more than 300,000 children each year in our pediatric hospitals, specialty clinics and primary care practices in Delaware, Florida, Maryland, New Jersey and Pennsylvania. Nemours strives to ensure a healthier tomorrow for all children – even those who may never enter our doors – through our world-changing research, education and advocacy efforts. At Nemours, our Associates help us deliver on the promise we make to every family we have the privilege of serving: to treat their child as if they were our own.
The Physician Referral/Authorization Specialist is responsible for obtaining and processing Elective, Urgent, and Emergent referrals and authorizations for physician based services and some office based services, including but not limited to cardiology and audiology tests. The Physician Referral/Authorization Specialist is also responsible researching and notifying family of co-payment responsibilities. Referrals and authorizations are obtained prior to the date of service as per department standards. During the referral process the Physician Referral/Authorization Specialist will partner with the Primary Care Practitioner to obtained required referrals. During the authorization and notification process the Specialist will provide the payor with all patient information and requested documentation necessary to obtain admission approval.
This role is required to utilize all available resources to verify eligibility, benefit levels, and patient copayment responsibilities.
This position collaborates with: Hospital Authorization department, non Nemours physician offices, managed care department and Nemours Physicians, and Departmental Administrative Staff to ensure that accurate information is collected and distributed effectively and efficiently.
The Specialist utilizes daily reports and work queues to complete follow up on non-approved cases and assure completion prior to admission date according to department standards.
In addition, the Specialist will attend daily departmental huddles to report on payor issues, barriers impacting workflows, and specific issues that could result in a non-reimbursable visit.
The Specialist Physician Referral/Authorization is required to provide excellent, customer focused and efficient service to both internal and external customers and represent Nemours in a positive, professional manner.
In addition to the Physician Referral/Authorization Specialist I responsibilities, the Specialist will have the ability to cover all referral and most authorization visit types, participate in organizational committees/task forces, attend payor meetings and demonstrate effective utilization of EPIC applications as indicated by performance measures.
This position will also assist with new associate training and provide guidance around their specialty to other associates.
Referral/authorization experience required
High School Diploma required
Expert knowledge of insurance vendor websites
EPIC experience a plus
Schedule: Monday through Friday, 8:30 am to 5:00 pm.
Our dedication to professionals who are dedicated to children frequently earns Nemours a spot on the list of top workplaces in the communities we serve. Our Associates enjoy comprehensive benefits, including our unique “Bridge to a Healthy Future” pediatric health plan, an integrated wellness program, opportunities for professional growth, and much more. As an equal opportunity employer, Nemours focuses on the best-qualified applicants for our openings.
Nemours is a pediatric health system of hospitals and specialty clinics serving children and families throughout the Delaware Valley and Florida. Our dedicated professionals integrate medical care, research, health education, and prevention to help improve the lives of children every day.