Patient Care Representative

2 weeks ago


La Habra, California, United States North American Staffing Group Full time
Job Summary

The Patient Care Representative will work closely with the clinical staff, claims and billing departments to ensure seamless authorization processes. This role requires excellent communication, organization, and follow-up skills, with the ability to handle multiple assignments simultaneously.

Key Responsibilities:
  • Obtain prior authorization information in accordance with established guidelines.
  • Verify prior authorizations and/or pre-service requirements are met.
  • Timely completion of all prior and retro authorization requests.
  • Proactively manage and maintain all authorization requests to ensure billing of clean claims.
  • Provide outstanding customer service to participants and develop and maintain positive working relationships with internal and external customers.
  • Identify and report trends and prior authorization issues relating to billing and reimbursement.
  • Document all account activity and correspond to inquiries in a timely manner.
  • Review accounts on a daily basis while meeting or exceeding all daily, weekly, and monthly production goals.
  • Responsible for documenting authorization status and demonstrating proficiency with software systems and electronic health records.
Requirements:
  • Excellent communication and organizational skills.
  • Ability to work independently and in a team environment.
  • Strong attention to detail and problem-solving skills.
  • Proficiency with software systems and electronic health records.


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