A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.
M-F 8-4:30p Work where every moment matters. Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network. Hartford Hospital is one of the largest and most respected teaching hospitals New England. We are a Level 1 Trauma Center that provides cutting edge treatment to its patients. This is made possible by being home to the largest robotic surgery center in the Northeast and the Center for Education, Simulation and Innovation (CESI), one of the most-advanced medical simulation training centers in the world. When hospitals cannot provide the advanced care, expertise and new treatment options their patients require, they turn to us.
Job Summary:
The Prior Authorization Specialist is responsible for processing and submitting authorizations, also in correspondence with providers, patients, insurance companies, specialist, and other healthcare representatives. The Prior Authorization Specialist ensures that all referrals and authorizations are documented completely and submitted in a timely manner. Communicate authorization denials to ordering physicians. Responsibilities include but are not limited to job responsibilities listed below.
Job Responsibilities:
Initiates prior authorization for all radiology exams requested by staff, providers, and or insurers. Documents all prior authorization activities and record activity in EPIC accurately. Prioritize and organizes all prior authorization activities Serve as a liaison between patient, insurer, and practice Prints and reviews the scheduled appointments up to three days in advance to ensure proper obtaining of authorizations and pre-certification prior to services being rendered Identifies and resolves problems with the scope of the job duties. Notifies manager of any situation or issue that is out of the ordinary. Work on denials and write off's Prepares written communication to notify appropriate staff of authorization updates and or changes for insurance carrier. Responsible to update patient changes of insurances and coverage issues in a timely manner Perform other related work, as assigned by manager Qualifications High School Diploma or Equivalent required, Associate Degree in business or health administration, finance, or health systems management highly preferred. 2-3 years' experience in the medical field, preferred 1-2 year experience with insurance authorization, preferred Experience working with Radiology strongly preferred Knowledge of CPT and ICD-10 coding practices Radiology billing and coding. Certified professional coder and experience in third party payer environment preferred. Medical Terminology Excellent communication skills. Communicates effectively with office staff, patients, and other appropriate parties. We take great care of careers. With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge - helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment. As an Equal Opportunity Employer/Affirmative Action employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.
