Description

JOB TITLE: Pre Authorization Specialist

DEPARTMENT: Business Office

GENERAL SUMMARY OF DUTIES: This nonexempt position is responsible for obtaining pre-authorization for all Office Visits, Cardiac device services, Imaging, In-Patient, Out- Patient, Catheterization Lab, and ASC (Ambulatory Surgery Center) procedures. This job requires the application and interpretation of insurance medical and payment policies and procedures. The individual must act as an on-site liaison for all departments, referring providers, insurance carriers, and patients for all eligibility and pre-authorization/certification functions. Communicating coverage/benefit determination to patient either in-person or via phone.

ESSENTIAL FUNCTIONS: (This list may not include all of the duties assigned.)

1. Responsible for obtaining prior-authorization for all office visits, cardiac device services, imaging, In-Patient/Out- Patient procedures and services, all ASC (Ambulatory Surgery Center) services for all payer types in a timely manner.
2. Collaborates with all team members and departments, including external providers, to ensure all patient demographic information and clinical notes are acquired prior to initiation of the prior-authorization process.
3. Acts as on-site liaison for the ancillary and clinical departments to internal and external referring providers, insurance carriers, as well as patients
4. Review patient eligibility, update patient demographics, document patient’s preferred facility.

EDUCATION:Some college preferred.

Minimum: High school diploma or equivalent

Preferred Certificate/License: Certified Professional Coder (CPC) required from AAPC

Experience:

Minimum: One year of experience in medical office with emphasis in commercial and government prior-authorization requirements.

PAY RANGE: $20-22/hr to start (dependent upon experience)

EMPLOYEE BENEFITS:

• Medical
• Dental
• Vision
• Colonial Life Elective Benefits
• Life Insurance
• Profit Sharing 401K
• HSA
• FSA
• Employee Assistance Program
• Wellness Program
• PTO- starting at up to 5.84 hours per pay period (increases with years of service)
• 8 paid holidays per year
• FMLA

This job description is intended to provide basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as needs evolve.

Qualifications

EDUCATION:Some college preferred.

Minimum: High school diploma or equivalent

Preferred Certificate/License: Certified Professional Coder (CPC) required from AAPC

Experience:

Minimum: One year of experience in medical office with emphasis in commercial and government prior-authorization requirements.