Description

JOB SUMMARY AND SCOPE

This position is responsible for obtaining pre-certifications and pre-authorizations for procedures and medications. This includes collecting all of the necessary documentation, contacting the patient or provider for additional information and completion of the required prior authorization to proceed with the procedure or testing. Responsible for documenting account activity, updating patient and claim information and demonstrates proficiencies with Cerner. This position is also responsible for working closely with the surgery scheduler including being able to schedule surgical cases when needed.

ESSENTIAL JOB FUNCTIONS

• Contact insurance carriers to verify patient’s insurance eligibility, benefits and requirements.
• Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services.
• Request, follow up and secure prior-authorizations prior to services being performed.
• Communicates any prior authorization changes or delays to surgery scheduler and schedules surgical procedures as needed.
• Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
• Communicate any insurance changes or trends among team.
• Maintains a level of productivity suitable DECH/CCH.
• Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.
• Demonstrates a clear understanding of, and commitment to, the hospital’s mission, vision and values as well as the service excellence standards while completing all tasks and responsibilities.
• Seeks out needed information, staying informed and involved by attending meetings, reading memos, policies, meeting minutes, newsletters, email and other appropriate information in a timely manner.
• Reliable attendance and punctuality, including observing appropriate break times and extending a scheduled shift when necessary to meet patient demands
• Performs duties in a safe manner, in compliance with all safety policies and procedures
• Complies with the Code of Conduct and all appropriate policies and procedures
• Other duties, as assigned, that are relevant to the position and department

DECH is dedicated to provided equal employment opportunity.

Requirements

MINIMUM REQUIREMENTS

• Licensure/Certification/Registration: None but Medical Billing Certification a Plus
• Education: Associates Degree in Medical Office Management Preferred but not required.
• Experience: Previous experience in a clinic setting preferred. Experience with an Electronic Medical Record a plus.
• Knowledge/Skills/Abilities: Must have excellent verbal and written communication skills. Requires effective customer relation skills, ability to organize and interpret data. Requires good judgment, tact, diplomacy, and ability to problem solve. Able to work effectively in a team environment. Able to use a personal computer and related software.