Functioning within the Health System's mission, values, objectives, policies and procedures, the Pre-Authorization Coordinator will manage the prior-authorization process for both outpatient and inpatient procedures. Enters appropriate data (dates, CPT codes, and insurance data) into ARM module in Meditech for diagnostic testing, surgeries, caths, and PTCA's. Accesses and uses payor websites (Availity, Navinet, Evicore, etc.) to verify insurance, submit authorization requests, and utilize tools within site. Assumes responsibility for staying current on clinical procedures and other information as related to job duties. Maintains current knowledge of which payors and procedures require pre-certifications and authorizations, and maintains necessary and accurate records.

Education:

High School diploma or equivalent (e.g. GED) is required. Completion of Medical Assisting or Medical Coding coursework is desired.

Licensure/Certification:

None required

Experience:

Three to five (3-5) years medical office or admissions and insurance experience is required. Working knowledge of ICD and CPT codes, as well as understanding of insurance payer medical policies.

Skills:

Must have excellent communication, organizational, and "customer service" skills, including the ability to exhibit patience and tact with all customers. Must have a working knowledge of ancillary department/support functions and diagnostic procedures. Knowledge of reimbursement/third party payer guidelines preferred.

Location:

Lima Memorial Health System •

Patient Registration Schedule:

Part Time, Days, 830 am-5:00 pm