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.
Description Cornerstone Family Healthcare is actively recruiting for a Prior Authorization Specialist to join our growing team in Middletown, NY.
RATE OF PAY/SALARY
$21.00 per hour
WORK LOCATION
(S):
Middletown, NY STATUS:
Full-time
CORNERSTONE'S MISSION
Cornerstone Family Healthcare is a non-profit Federally Qualified Health Center with a mission to provide high quality, comprehensive, primary and preventative health care services in an environment of caring, dignity and respect to all people regardless of their ability to pay. For more than fifty years, Cornerstone has been responsive to meeting the needs of the communities in which we serve with a continued emphasis on the underserved and those without access to health care regardless of race, economic status, age, sex, sexual orientation or disability.
CORNERSTONE BENEFITS
Competitive salaries I Health Benefits I Retirement plan
I Paid Time Off I Sick Time I Flexible Spending I Dependent Care I Paid Holidays Job Duties:
Assists patients in obtaining prior authorizations for treatment requiring insurance pre-authorization. Handles all prior authorization submissions to proper insurances. Documents in EMR authorization status, actions, and outcomes. Communicates well with internal providers to obtain all the required information to submit prior authorization efficiently. Has medical terminology knowledge, i.e. ICD, CPT, Procedure Codes/Names, & Test Names. Responsible for notifying the appropriate internal departments of any information that they need to be aware of, including complaints or adverse event notifications. Communicates and builds relationships with insurance carriers and servicing providers or facilities. Schedule peer to peer meeting between CFH provider and insurance company for prior authorization denials. Request and prepare supporting documentation for the medical necessity for the service being authorized, examples include medical records, labs, previous prior authorization(s), appeals, denials and prescriptions. Sorts daily work queues and is accountable to identify and process the daily work. Preforms initial insurance benefit verification and pre-surgical authorization for new OB/GYN or Podiatry surgical cases. Advises Provider and patients of any changes or cancellations of surgical/procedure bookings. Fields phone calls from staff and service providers and resolves inquiries related to prior authorizations. Easily manages multiple authorization requests at once. Exemplifies excellent customer service with patients, visitors, and other employees; shows courtesy, friendliness, helpfulness, and respect. Consistently demonstrates respect for the capabilities, different cultures and/or personalities of internal and external customers. Maintains and ensures patient privacy and confidentiality. Takes the initiative to proactively assist others. Maintains open and effective communication with providers and employees to ensure quality. Perform other related duties as assigned Requirements Bilingual (English & Spanish) At least one-year clerical experience in a health-related field Knowledge of data entry Pleasant telephone manner
