Senior Financial Clearance Specialist; Prior Insurance Authorization ; V.. exp pre

Organization: VEI Oph Services 200

• Obtains certification from insurance companies for all elective out‑patient specialty surgeries for both the surgeon and the facility.
• Contacts insurance review agencies to request authorization.
• Handles problematic certification cases with relevant internal groups.
• Performs investigative and follow‑up work on cases with pre‑certification issues until the issue is resolved.
• Documents certification process in the appropriate applications to facilitate accurate concurrent review, billing and reimbursement.
• Coordinates co‑pays or monies to be collected from the patient.
• The responsibilities listed are a general overview of the position and additional duties may be assigned.
• Performs tasks to support and obtains pre‑certifications from insurance companies.

• Organizational Impact:
  Performs non‑routine tasks that significantly impact team's performance with minimal guidance.
• Problem Solving / Complexity of work:
  Conducts research and analysis to solve some non‑routine problems.
• Breadth of Knowledge:
  Applies broad job knowledge and has basic job skills in other areas.
• Team Interaction:
  Provides informal guidance and support to less experienced team members.

• Supporting Colleagues
  • Develops Self and Others:
    Continuously improves own skills by identifying development opportunities.
  • Builds and Maintains Relationships:
    Seeks to understand colleagues' priorities, working styles and develops relationships across areas.
  • Communicates Effectively:
    Opensly shares information with others and communicates in a clear and courteous manner.
• Delivering Excellent Services
  • Serves Others with Compassion:
    Invests time to understand the problems, needs of others and how to provide excellent service.
  • Solves Complex Problems:
    Seeks to understand issues, solves routine problems, and raises proper concerns in a timely manner.
  • Offers Meaningful Advice and Support:
    Listens carefully to understand the issues and provides accurate information and support.
• Ensuring High Quality
  • Performs Excellent Work:
    Checks work quality before delivery and asks relevant questions to meet quality standards.
  • Ensures Continuous Improvement:
    Shows eagerness to learn new knowledge, technologies, tools or systems and displays willingness to go above and beyond.
  • Fulfills Safety and Regulatory Requirements:
    Demonstrates basic knowledge of conditions that affect safety and reports unsafe conditions to the appropriate person or department.
• Managing Resources Effectively
  • Demonstrates Accountability:
    Takes responsibility for completing assigned activities and thinks beyond standard approaches to provide high‑quality work/service.
  • Stewards Organizational Resources:
    Displays understanding of how personal actions will impact departmental resources.
  • Makes Data Driven Decisions:
    Uses accurate information and good decision making to consistently achieve results on time and without error.
• Fostering Innovation
  • Generates New Ideas:
    Willingly proposes/accepts ideas or initiatives that will impact day‑to‑day operations by offering suggestions to enhance them.
  • Applies Technology:
    Absorbs new technology quickly; understands when to utilize the appropriate tools and procedures to ensure proper course of action.
  • Adapts to Change:
    Embraces changes by keeping an open mind to changing plans and incorporates change instructions into own area of work.

• Insurance Regulatory Knowledge (Advanced):
  Demonstrates knowledge of the appropriate rules and regulations for insurance policies, claims, payment and coverage. Ability to interpret and explain rules and regulations that are ambiguous or unclear.
• Customer Service (Intermediate): A continuing focus on the needs and requirements of customers, anticipating their needs, remaining sensitive to customers while performing services for them, responsive to customer needs.
• Data Entry (Intermediate):
  The ability to transcribe information from the original source into an electronic system according to written and verbal instructions efficiently and accurately.
• Problem Solving (Intermediate):
  Uses critical thinking and process improvement i.e. coaches and…