Job Summary:

Reviews, verifies, and processes prior authorizations in the department's work queue. Serves as a resource to patients, staff, and medical providers for prior authorizations.

PRINCIPAL DUTIES AND RESPONSIBILITIES:
Under general supervision, follows established policies and procedures and applies acquired job skills to verify insurance rejections and contact clinics to initiate and receive information to complete prior authorizations for patients. Assists clinics and patients with understanding prior authorizations and their medical (and possibly the pharmacy) benefits as required. Educates patients and clinic staff regarding requirement for insurance plan to complete prior authorization. Answers inbound inquires related to prior authorizations and assists billing group on insurance claims. Completes outbound calls to payors and clinics to assist with prior authorizations.

• Verifies insurance coverage related to prior authorizations by phone, online or through E1 (electronic system) transactions for all new patients and/or changes in coverage.
• Enters patient insurance information under the patient's account in the system if not already done by front office staff, or asks office staff to enter.
• Ability to review multiple authorization platforms simultaneously to complete daily tasks.
• Shows knowledge and understanding of insurance billing and prior authorization requirements demonstrating analytical thinking.
• Monitors all patients' prior authorizations to ensure that it is initiated and progressing through the system.
• Performs functions that require full knowledge of general aspects of the job.
• Works on assignments that are semi-routine in nature, but recognizes the need for occasional deviation from accepted practice.
• Ensures that tests have been ordered that are reflective of the insurance company policies for specific medications.
• Reviews the DAR and work queues regularly to maintain authorizations and is proactive to renewals.
• Stays current with the payer policies through electronic, mail or fax bulletins and reviews major changes with supervisor.
• Quickly identifies need for authorization initiation or modification due to insurance policy changes.
• Escalates issues to supervisor for resolution, as deemed necessary.
• Reviews and complies with all applicable Department of Medicine policies and procedures, local, state and federal laws and regulations.
• Assists with various projects as assigned by direct supervisor.
• Other duties as assigned.

Additional responsibilities may include focus on one or more departments or locations. Minimum Qualifications:

High School degree or equivalent and two years clerical support in a medical billing setting. Will consider equivalent combination of education and experience.

Preferred Qualifications:

 

Work Days:

Monday - Friday daytime hours

Message to Applicants:

Our benefits package includes health, dental and vision insurance, eligibility for employer 401k funding after 1 year (3% quarterly/5% annual on vesting schedule), tuition reimbursement, generous paid time off, including vacation and personal time, paid sick leave, holidays and floating holidays.

G3: $16.00 - $25.88

Please note the salary information shown is a general guideline only. Salaries are based upon candidate skills, experience, and qualifications, as well as internal equity, market and business considerations.

Recruitment  Office: MedBest Medical Management