At Ashe Memorial Hospital, we are driven by our Mission Statement, "To meet the needs of the community by delivering patient-centered, high quality health care."

Ashe Memorial Hospital is proud to be Voted Ashe's Best Place to Work 2022 & 2023! Come be a part of our dynamic team; you'll join Ashe's 2022 & 2023 Best Hospital, Best Surgeon, Best Physician, Best Nurse, and Best Medical Practice! This is your opportunity to make a large difference in a small community!

Hours: Mon. - Fri, 8am - 5pm | No Supervisory Responsibilities | No Travel | Pay commensurate with experience

Full time position at Ashe Women & Children's

JOB SUMMARY:

The Prior Authorization/ Billing Coordinator is responsible for obtaining prior authorizations for medications and diagnostics, outpatient testing and coordinating patient orders from multiple providers. Responsible for sending and tracking patient referrals to outside specialists, etc. in a timely manner through an electronic medical record system. Coordinates record reviews and assists requesters with access to and release of information. Responds to requests for medical information by performing duties in accordance with established Ashe Memorial Hospital and Departmental policies and State and Federal laws.

Complete and processes original billing for one or more payor classes. Works hold buckets regarding claims in EMR system. 

Minimum Job Qualifications:

Education:

• High School graduate preferred.
• Knowledge of standard office equipment preferred.
• Business courses and/or hospital business office experience preferred.

Job Knowledge:

• Knowledge of CPT coding, ICD 9 Codes, and Medicare Reimbursement issues preferred.
• Knowledge and skills appropriate to working in a rehabilitation setting preferred.
• Medical terminology highly desirable.

Experience:

• Previous healthcare office setting preferred.

ESSENTIAL FUNCTIONS:

1. Contact insurance carriers to verify patient’s insurance eligibility, benefits, and requirements.

1. Request, track, and obtain prior authorization from insurance carriers within time allotted for medical services.
2. Request, follow up, and secure prior authorizations prior to services being performed.
3. Coordinates the release of medical information to all requesters, including patients, physicians, and other health providers within 5 days of receiving request.
4. Processes subpoenas and court orders within time frames on subpoena or court order.
5. Verifies authorizations in accordance with Ashe Memorial Hospital policy and procedures and state and federal laws.
6. Maintains security and confidentiality regulations for record access and review. Consults practice Manager or Director with any unusual requests.
7. Familiar with the components of a valid court order or subpoena.
8. Possesses the ability to pull together an accounting of released information for patients on demand.
9. Follows departmental policies and procedures when releasing protected health information (PHI) to Clerk of Court or any authorized requester.
10. Prepares records for storage. Responsible for retrieval of stored records at storage facility.
11. Maintains a level of productivity suitable for the department.
12. Clearly documents all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.
13. Submits insurance claims electronically. Prepares claims to go via paper including backup documentation.
14. Researches all information to complete billing process (e.g., edits, errors, etc.). Stays abreast of all billing regulations and/or updates.
15. Answers all inquiries regarding accounts, including patient and staff inquiries.
16. Works hold buckets daily within EMR System as claim follow up is needed to insure timely completion of problems. Sends folders to appropriate department when edits require. Notes are made on account and action is logged/tracked.
17. Requires knowledge of MCR and MCD software programs for filing claims, follow-up, correcting suspended claims, etc.
18. Quality of work. (Work conforms to professional expectations: accurate, neat, legible, and thorough.)
19. Quantity of work. (Can handle a large workload effectively, efficiently, and in an organized manner.)
20. Demonstrates flexibility in adapting to job changes and taking on other responsibilities. (In a changing environment, has the skills and willingness to adapt to changes in job responsibilities and job demands.)
21. Displays a positive attitude toward work; contributes positively to office morale.
22. Ability to get along with other staff. (Can get along with other staff consistently and effectively; coordinates well with other staff.)
23. Enhances professional growth and development through in-service meetings, education programs, etc.
24. Assists in the care and maintenance of department equipment and supplies. Alerts supervisor of equipment malfunctions. etc. Completes supply order properly.
25. Performs other duties as assigned.

Must be willing to receive all required vaccinations (i.e., flu shot, etc.). All new employees working must be fully vaccinated as a condition of employment (unless the new hire has requested and received an exemption). Candidates for employment will be notified of this policy requirement prior to the start of employment. After receiving an offer of employment, new employees must provide proof of vaccination or request and receive an exemption before beginning work.

To apply, please fill out an application, attach a cover letter, and resume. Include gaps in employment and reasons for separation.

Criminal background check and pre-employment drug screen required upon conditional job offer.

***Benefits apply the 1st of the month following employment, per policy.***

*For full job description and benefits, please contact Human Resources.

Ashe Memorial Hospital is an equal opportunity employer and, as such, considers individuals for employment according to their abilities and performance. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising patient care. Employment decisions are made without regard to race, age, religion, color, sex, national origin, physical or mental disability, marital or veteran status, sexual orientation, genetic information, or any other classification protected by law. All employment requirements mandated by local, state, and federal regulations will be observed.