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Title: Pre-Authorization Specialist

Location: Upper East Side

Org Unit: Clinical Operations

Work Days: Monday-Friday

Weekly Hours: 35.00

Exemption Status: Non-Exempt

Salary Range: $34.78 - $37.80

*As required under NYC Human Rights Law Int 1208-2018 - Salary range for this role when Hired for NYC Offices

Position Summary

Under direction, is responsible for the management of insurance verifications, eligibility and benefits, and prior authorizations for services provided. Serves as liaison between junior pre-Authorization staff and department leadership.

Job Responsibilities

• Verifies pre-authorizations and obtains upgrades if needed. If pre-authorization is not obtained for next day, notifies referring provider's office and contacts patient to provide option to reschedule or sign a financial waiver of liability.

• Verifies patient insurance eligibility and obtains necessary pre-authorization numbers, if required, prior to appointment date. Facilitates the communication and collection of any fees due from patient.

• If applicable, ensures that provider participation database is updated as new insurance plans/products are identified during the verification/authorization process.

• Assists financial clearance and billing matters as needed, including but not limited to denial management WQs, CPT adjustments, research AR, and compliance.

• Assists with creation and implementation of department workflows, standards, and policies. Disseminates information to colleagues and/or staff as appropriate, including organized trainings for senior staff and new hires.

• As needed, offers support to junior pre-authorization staff regarding patient inquiries, disputes, etc.,

• Performs other related duties as directed.

Education

• High School Diploma

Experience

At least two (2) years prior related experience within the medical field.

Knowledge, Skills and Abilities

• Demonstrated experience with insurance verifications, and pre-authorization procedures.

Licenses and Certifications

Working Conditions/Physical Demands

Standard office work

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Cornell University embraces diversity in its workforce and seeks job candidates who will contribute to a climate that supports students, faculty, and staff of all identities and backgrounds. We hire based on merit, and encourage people from historically underrepresented and/or marginalized identities to apply. Consistent with federal law, Cornell engages in affirmative action in employment for qualified protected veterans as defined in the Vietnam Era Veterans' Readjustment Assistance Act (VEVRRA) and qualified individuals with disabilities under Section 503 of the Rehabilitation Act. We also recognize a lawful preference in employment practices for Native Americans living on or near Indian reservations in accordance with applicable law.