Preauthorization Specialist
4 weeks ago
Description
Job Summary:
Underthe direction of the Financial Coordinator Supervisor, ensures that all information necessary for properfinancial reimbursement for high dollar patient care is analyzed and submittedto insurance companies for approval prior to the patient’s date of service. Collaborateswith insurance companies and physician offices when necessary to verifyeligibility and authorization requirements to ensure financial reimbursementfor services.
Essential Functions:Performall insurance verification for eligibility, coverage, and authorizationrequirements via Web or phone with third party payers.
Ensures all possible coverages are created and verified, through electronic or manual methods, and all discrepancies are resolved. Validates that coverages are assigned to appropriate visit. -Collects and validates order-related information including office visit, radiology and surgical orders. Follows up with ordering provider to verify CPT codes. Escalates challenging accounts to team lead to ensure accounts are approved at prior to patient appointment/surgery. Escalates non-certified urgent cases to appropriate clinical departments and leadership for approval to proceed or communicate rescheduling.Contacts providers andinsurance companies to validate data, collect missing information and resolveinformation discrepancies, -Understands clinical guidelines for payorsrequiring authorization to better build cases for authorization requests andprovide feedback to clinical departments on required notes.
Workclosely with physician offices obtaining authorization for inpatient andoutpatient services
Workcollaboratively with Case Management for all patients’ financial issues andupdating accounts
Qualifications
Qualifications:
EducationHighschool graduate or equivalent; some college preferred
Experience1-2 years of insurance, third party payor or secretarialexperience in a health care setting required
Knowledgeand Skills
MedicalTerminology required
Analyticalability to gather and interpret data and communicate desired outcomes orallyand in writing in a professional manner
Strongcommunication and interpersonal skills
Abilityto handle multiple duties
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