Elliot Health System
2 months ago
Come work at the best place to give and receive care
?Job Description:
Position Summary
The Clinical Prior Authorization Representative is responsible for ensuring that precertification is completed for patients which is required by insurance payors. The incumbent will perform general administrative duties that support the providers and clinical needs.
We encourage medical assistants, pharmacy techs or others with pertinent clinical experience to apply as this would be ideal for that skill set
Key Responsibilities
- Obtain approval by researching ICD-10 coding, completing all necessary authorization forms, ensuring that clinical information is provided to insurance companies, and authorization is complete.
- Interact with staff to share information and receive updates regarding patient status or procedure. Serve as a resource and educate staff on process required for precertification.
- Interact with Patient Accounts to resolve billing and precertification issues. Provide supportive documentation as needed.
- Verify all self-pay accounts and conduct any necessary research to determine absence of any other insurance.
- Develop the proficiency necessary on current equipment used including electronic medical records, word processors, mainframe computer terminals, or other such devices.
- Maintain all electronic files, logs, and records for easy retrieval and to accurately track production for present and future references.
- Ensure confidentiality of employee, legal, client/patient, budget and all company matters.
- Perform visit chart preparation activities based on the daily scheduled appointments including diagnostic test results, emergency/urgent care reports, discharge summaries and consult/PCP reports are located in the medical record and accessible to the provider.
- Document using clear, concise and professional written skills.
- Process medication prescription refills per guidelines using telephonic, electronic or print methods.
- Communicate with patients in a timely, courteous, and professional manner using oral, written, telephonic or electronic means. Handle patient complaints or negative feedback in a professional manner and directs to manager/director appropriately.
- Identify emergent situations and communicate to appropriate personnel for interventions.
- Participate in and support quality and regulatory activities, teamwork, and professional relationships within the organization.
- Participate in continuing education activities to enhance own knowledge and skills.
- Cross train as a patient service representative as needed, including telephone coverage.
Education/Experience/Licensure
- Education: High School diploma or GED required. Graduate of an accredited Medical Assistant program or equivalent clinical experience in a healthcare related field required.
- Licensure: Medical Assistant certification preferred.
- Experience: A minimum of one year of Medical Assistant or similar clinical experience preferred. Experience in customer service relations and/or office experience preferred.
What Elliot Health System Has to Offer
- Health, dental, prescription, and vision coverage for full-time & part-time employees
- Short-term disability, long-term disability, and life insurance coverage
- Competitive pay
- Tuition Reimbursement
- 403(b) Retirement Savings Plan
And more
#EKH
Work Shift:
Monday-Friday, 8am-5:00pm, 32 hours weeklySolutionHealth is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, disability status, veteran status, or any other characteristic protected by law.
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