Description

JOB SUMMARY: Checks appointments and tasks/messages to make sure the diagnosis/documentation will support medical necessity, as per insurance company, and verify that all visits and procedures that need preauthorization are pre-authorized. Follow and verify all authorizations for recurring infusions/therapies. Works closely with referring offices to be used as a resource in helping them get necessary paperwork to start pre-authorizations, prove medical necessity, or to perform a retro-authorization. Works closely with co-workers and vendor representatives to get visits/procedures approved.

DUTIES AND RESPONSIBILITIES:
Mountain View Infusion Insurance/Pre-authorization Specialist

1. In a professional and friendly manner, answers incoming phone calls transferred to preauthorization department, answers preauthorization questions from patients, co-workers and providers.
2. Secures physician orders and uses all patient information for charting, billing and record keeping purposes.
3. Accurately, and in a timely manner, processes requests for office visits and procedures to be sent from other facilities and physician’s offices.
4. Verifies all patients have appropriate diagnosis for each therapy to support medical necessity according to LCD’s and payer policies, when submitting prior authorization requests.
5. Works closely and professionally with referring providers when infusion/therapy authorization needs to be done and/or is denied reimbursement to help the provider get all paperwork in order to start the authorization process, prove medical necessity, and/or retro-authorization.
6. Works directly with Billing Office in denials.
7. Maintains flexibility as department grows with willingness to accept additional responsibilities requested by department manager/supervisor/director.
8. Acts professional in every situation: patient, co-worker or intradepartmental.
9. Recognizes that many people we see are at a low point in their lives and will show compassion for them even if it is only a smile.
10. Protects information that is sensitive, proprietary or confidential in nature. Adheres to Patient Rights Policy and patient confidentiality standards.
11. Works to provide functional and safe surroundings for patients and staff (i.e., safety, security, infection control, etc.). Strives to always promote personal and patient safety. Demonstrates awareness of the location of applicable hospital and department specific manuals.
12. Completes all annual mandatory education requirements (including hospital, department, and job specific competencies).
13. Attends the required number of staff meetings per department standard.
14. Arrives at work station and is ready to work at the designated start time.
15. Is willing to do assignments, cross-training, or tasks within the scope of his/her job description, as asked by the manager, which are deemed necessary to meet the needs of the department.
16. Maintains adaptability. Adapts to change in a positive and professional manner. Accepts responsibility for his/her actions, attitudes and mistakes without placing blame.
17. Is accountable for completing all assigned responsibilities/tasks and takes action when opportunities to improve are identified.
18. Promotes effective working relationship and works effectively as a part of the department/team to facilitate the hospital and department’s ability to meet its goals and objectives.
19. Responsible for authorization follow-up for new and recurring infusions and therapies.
20. Work as a backup for the Admissions Clerk. This includes admitting patients, helping with paperwork, files, answering phones, and filling in when the Admissions Clerk is out of the office.

Qualifications

QUALIFICATIONS:

Education: High School graduate or equivalent. Knowledge of diagnoses and CPT codes for authorizing infusion services preferred.

Experience: Prior experience with coding and billing for outpatient billing is preferred.

Language/Communication: Ability to communicate well with patients, co-workers and vendor representatives.

Mathematical Skills: Basic math

Mental Capabilities: Continuously able to concentrate on fine detail with interruptions and continuously able to attend to task/function for an extended period of time. Ability to learn computer programs and input data as required.

Interpersonal: Ability to work well with others.
Performance: Writing skills necessary to properly submit preauthorization requests with insurance companies. Appropriate phone etiquette to properly submit preauthorization requests with insurance companies. Holds the judgment, tact and diplomacy to effectively resolve conflicts.