Pre-Authorization Coordinator
2 weeks ago
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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