PRIOR AUTHORIZATIONS

ESSENTIAL FUNCTIONS:

• Initiates and process prior authorization requests from healthcare providers for medical procedures and surgical services.
• Verify patient insurance coverage and benefits to determine requirements for prior authorization and collaborate with Artesia General providers, insurance companies, and patients to facilitate efficient authorization processes.
• Maintain accurate records of authorization requests, approvals and denials
• Communicate with providers and front-end office, insurance companies, and patients regarding authorization status, requirements and appeals.
• Prepare and submit prior-authorization appeal requests as necessary
• Communicates with patients their copay, out-of-pocket, co-insurance and deductible amounts.
• Familiarity with insurance plans, authorization processes and coverage policies
• Accurate data entry and record keeping.

KNOWLEDGE/SKILL/ABILITIES:

• Proficiency in using electronic medical records systems
• Understanding medical terminology, procedures, and healthcare regulations
• Clear and effective communication and verbal skills
• Accurate data entry and record keeping
• Ability to resolve issues related to authorization request and denials.
• Ability to work independently and professionally.

EDUCATION AND EXPERIENCE

• High School Diploma and or GED
• Previous experience in healthcare medical billing and insurance authorization, preferred
• Ability to work overtime to meet deadlines or handle urgent authorization request.

AGE-RELATED COMPETENCIES: Demonstrates the basic knowledge and skills (cognitive, technical and interpersonal) necessary to identify age-specific patient needs appropriate for all age groups.

Information Management: Treats all information and data within the scope of the position with appropriate confidentiality and security.

Risk Management/Quality Management/Safety: Cooperates fully in all Risk Management, Quality Management, and Safety Activities and Investigations.

ENVIROMENTAL CONDITIONS: Work environment consists of daily patient contact, which may include exposure to blood, or other body fluids.

MINIMUM POSITION QUALIFICATIONS:

• Education - High School Diploma
• Work Experience - Customer service experience preferred, good communication skills required, bi-lingual capabilities preferred. Minimum of one year of prior authorization experience preferred.
• Training - N/A
• License/Certification - N/A