Prior Authorization Rep

Job description

QUALIFICATIONS
Education
• High school diploma or equivalent
• Associate degree preferred

Experience/Skills
• Has one year patient access, medical billing, or prior authorization experience
• Possesses medical terminology and CPT/HCPCS/ICD-10 coding knowledge
• Demonstrates proficiency in Meditech and MS Excel
• Professionally collaborates with staff at various levels throughout the organization, including, but not limited to: Physician Practices, HIM, Information Systems, Patient Financial Services and Clinical Directors
• Works efficiently with minimal supervision
• Remains flexible to accommodate staffing shortages in the Patient Access department

Required Licenses/Certifications
• N/A

Working Conditions
• Works in a well-ventilated, well-lit general office environment
• Works well under pressure with attention to time constraints

ROUTINE RESPONSIBILITIES
Behavioral Expectations
• Consistently complies with established Behavioral Expectations

Essential Duties
• Verifies insurance eligibility and benefits directly with payer or on payer Website prior to starting the authorization process
• Identifies and documents each payer policy and procedure regarding coverage and items that require prior approval
• When applicable, verifies that Medicare diagnosis support service and frequency guidelines are not exceeded
• Manages daily work queues to ensure prior authorizations are submitted timely and accurately
• Ensures that notification of authorization approval or denial is communicated timely to the ordering physician’s office and to the patient
• Follows up with payers to check status of previously submitted prior authorizations
• Works directly with Director of Revenue Cycle to identify trends in denials and opportunities for improvement in the authorization process
• Implements a payer-specific check list for eligibility, benefits, and authorization to cover pre-financial clearance

Full time/Day shift
80 hours/Biweekly