Precertification/Prior-Authorization Coordinator
3 weeks ago
Supports practice revenue goals by obtaining precertification/prior-authorization for all imaging for in-house and outside facilities. Also obtains prior-authorization for all surgery's performed by Penta physicians and all in-house procedures that require precert.
Essential Functions:
- Facilitates practice goals for obtaining proper precertification/prior-authorization requirements for in-office procedures, in-office and outside imaging and all surgery's. Communicates well with physicians, staff and patients in meeting these goals.
- Verifying patient demographic information to ensure proper insurance information has been entered into our PM system. Contacting insurance companies to check if prior-authorization is required and what the individual benefits for the patient are to get out of pocket cost for the patient.
- Contacting patients once scans or surgery's are booked to inform them of what they will be required to pay upfront. Documenting the patients chart with all appropriate information for proper follow up.
- Following practice protocols for booking patients appointments for imaging and in-office procedures as well as communicating necessary information back to surgery schedulers for them to book patients for their surgery.
- Working with direct supervisor on problems with patient accounts, scheduling conflicts, or any problems that may arise.
- Maintains open, clear, communication with physicians, staff, patients and direct supervisor to coordinate the prior-authorization and booking process.
- Maintain clear vision of what the process should be and stay organized to ensure proper steps are followed for ease of the patients and the practice.
- Coordinate work flow between insurances sites to Allscripts and phreesia systems to reflect proper payments were obtained as well as follow up on fax communication for approvals, denials or pending transactions and keeping appropriate staff in the know.
- Supports the attainment of patient satisfaction goals by explaining insurance policy requirements, benefits and filing rules to patients; answering patient questions regarding account status, charges, co-pays, deductibles, non-covered services, etc.; resolves patient complaints.
- Works well independently as well as part of a team of individuals and can prioritize work easily.
Minimum Requirements:
- High school diploma or equivalent; relevant Associates degree (e.g., Health Information Technology), RHIT and/or certification (e.g., CPC) preferred
- None required; at least two (2) year's precert/prior-authorization experience in a medical group practice or hospital setting preferred
Key Competencies:
- Coding (CPT, ICD-9, HCPCS, etc.) knowledge
- Problem Solving
- Computer literacy (especially practice PMS)
- Customer service
- Medical Terminology
- Detail-oriented
- Communication skills (verbal and written)
- Listening skills
- Ability to ask for money/payment
- Teamwork/team participation skills
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