Pre-Authorization Specialist

This position facilitates timely access to care by ensuring insurance eligibility and benefits are verified prior to service and working with insurance companies. This position will work with the financial counselor and the utilization nurse to obtain prior authorizations to support claim payment. Resolve pre-certification, registration, and case-related concerns prior to a patient's appointment. Has knowledge of commonly used medical terms and procedures. Rely on instructions, protocols and pre-established guidelines to perform the functions of the job.

The individual will evaluate all surgery authorizations, reviewing them for accuracy and completeness; review patient demographics and insurance verification; coordinate preparation of reports and other documentation requests by insurance carriers, etc.; perform a critical public relations function of providing pleasant, knowledgeable verbal and written representation of the clinic in all daily business contacts. The listing of duties contained in this job description is not all inclusive. Duties may be added or subtracted at any time due to the needs of the organization. Department goal is to verify all scheduled surgeries at least 2-4 business days prior to the date of service and to check for add-ons at least twice daily to ensure that authorizations are verified and correct. Prioritize work assignments, ensure on-time completion of tasks and projects and provide timely updates to the Case Management Manager. Always displaces courtesy and sensitivity. Responds promptly, courteously and professionally to customer needs whether in person, or by telephone. Works closely with physicians, nursing, ancillary departments, patient financial services, patients, insurance companies and families with equal respect and understanding. Demonstrates an in-depth understanding of the computer systems required to complete this position and demonstrates a through working knowledge of such Welcomes newly assigned tasks and projects and learns new skills as needed to adapt to organization change. Accepts criticism and feedback in a positive manner. Changes approach or method to best fit the situation. Review and analyze all surgical orders for completeness via electronic medical record. Verify facility is appropriate per patient's insurance coverage. Displays an understanding third-party payer regulations related to managed care, denials and reimbursement issues. Has working knowledge of current hospital contracts with third-party payers. Follows up on accounts as necessary to ensure codes are prior authorized appropriately prior to procedure being performed. Obtains required prior authorizations for inpatients and outpatient procedures prior to procedure being performed. Give priority to add-ons and same-day surgeries in order to make every effort to verify eligibility and benefits prior to service. Update patient account to indicate pertinent information (e.g. Insurance has been verified, authorization numbers, etc.)

Requirements:

Preferred, 2 years' prior experience in Preauthorization billing, insurance, appointment scheduling or directly related experience in a health care environment. Preferred Knowledge of medical terminology/Knowledge of CPT and coding skills; knowledge of computerized office systems; knowledge of third party payer requirements; Completion of a high school education or equivalent. Organize/prioritize work; to work in an environment with patient populations of acute, chronic, and complex disease processes; to follow written and oral instructions; to detect, resolve, and correct problems; to react and perform in stressful situations.