Office Specialist - Cardiovascular Consultants

Job description

JOB TITLE: Office Specialist
REPORTS TO: Practice Manager
SUMMARY OF POSITION:
• Ensure prior authorization obtained for all upcoming testing and procedures ordered by physicians
• Work closely with nursing staff, local hospitals and insurance companies to ensure upcoming procedures are covered by patient's health plan.
• Honor patient and co-worker confidentiality
• Other duties may be assigned by the Practice Manager

DUTIES:
• Understand the different insurance plans and policies that are accepted by CVC and rendering facilities.
• Obtain precertification number on all testing and procedures that are ordered by a physician
• Determine patients in and out of network benefits and which rendering facility will be the most compatible with the patient's insurance
• Process Yes You Can forms for all non-Medicare, Medicaid patients with out of networknsurance for all testing and procedures done at Aultman Hospital
• Know the correct CPT and ICD-IO coding for the ordering test or procedure
• Keep in constant contact with the insurance company on pending cases
• Able to research and give clinical information to insurance nurse reviewers
• Contact hospitals or other rendering facilities with the prior authorization number prior to test or procedure
• Handles triage and consultations calls and coordinates with physicians, fellows, emergency room and referring physicians, and hospital floors to get patients seen.
• Review chart documentation to ensure patient meets medical policy guidelines

WORKING CONDITIONS:
• Normally works 8 hours per day - Monday through Friday with a scheduled lunch every day
• May require paid overtime before and/or after normal working hours
• Works in well lighted and well-ventilated office
• Expected to adhere to general office policy
• Will not be exposed to blood and body fluids
• Will spend majority of day in front of computer terminal entering data, using telephone, faxes, copiers and printers
• Subject to frequent interruption

REQUIREMENTS:
• Knowledge of procedure authorization and its direct impact on the practice's revenue cycle
• Understanding of the payer medial policy guidelines while utilizing these guidelines to manage authorizations effectively
• Basic understanding of human anatomy, specifically cardiac
• Proficient use of CPT and ICD-IO codes
• Excellent computer skills including Excel, Word and internet use
• Detail oriented with above average organizational skills
• Plans and prioritizes to meet deadlines
• Excellent customer service skills communicate clearly and effectively
• Ability to multitask and remain focused while managing a high volume, time-sensitive workload

EDUCATION:
• High School Diploma or GED
• 2 years medical prior authorization experience preferred
• 3 years' experience in a medical related field require