Pre-Authorization Coordinator

2 weeks ago


Poughkeepsie, New York, United States Nuvance Health Full time
Job Summary: We are seeking a highly skilled Pre-Authorization Representative to join our team at The Heart Center in Poughkeepsie, NY. The successful candidate will serve as the coordinator for all scheduled and pre-authorized procedures, ensuring seamless communication with insurance providers and accurate authorization numbers.

Key Responsibilities:
  • Perform daily reconciliation of scheduled procedures, documenting authorization numbers obtained by others, as well as obtaining any authorizations and retroactive authorizations.
  • Communicate with insurance providers about the patient's medical necessity and obtain authorization for needed authorizations and reconcile to the authorization database and/or hospitals' systems.
  • Correct inaccurate information, CPT and ICD9 codes that prohibit pre-authorization, and ensure accurate charges are entered into Allscripts.
  • Recommend revisions and modifications to improve the integrity of the pre-authorization process for better identification of procedures to be performed.
  • Reconcile, update, and obtain retroactive authorization numbers from insurance providers.
  • Serve as a liaison and primary contact for Heart Center managers, physicians, clerical staff, and other appropriate staff.
  • Act as a liaison to Admitting and Outpatient Services, communicating frequently with them to resolve classification and data issues for consistent authorization.
  • Create a monthly report listing accounts that required retroactive authorization and maintain a case list, monitoring, evaluating, and reporting regularly on the number of cases to be verified.
  • Determine and communicate missing charges for cases to appropriate faculty and staff.
  • Participate in annual and ongoing mandatory compliance training and stay informed of changes in policy by reviewing regular Medicare bulletins and other relevant resources.
  • Be knowledgeable about compliance requirements with all federal and state healthcare laws, regulations, and rules, including Medicare and Medicaid billing requirements applicable to the employee's job duties.

Requirements:
  • High school diploma required or GED; college preferred; CPC preferred.
  • Comprehensive knowledge of third-party insurance billing policies and procedures and previous billing experience required.
  • Excellent communication and organizational skills; minimum of two years related work experience.
  • Demonstrated proficiency using PCs and hospital systems, including familiarity with Microsoft Access, Excel, and Word.
  • Demonstrated understanding of medical terminology.


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