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