What are the responsibilities and job description for the Prior Authorization Rep position at Sullivan County Community Hospital?
QUALIFICATIONS
Education
- High school diploma or equivalent
- Associate degree preferred
Experience/Skills
- Has one year patient access, medical billing, or prior authorization experience
- Possesses medical terminology and CPT/HCPCS/ICD-10 coding knowledge
- Demonstrates proficiency in Meditech and MS Excel
- Professionally collaborates with staff at various levels throughout the organization, including, but not limited to: Physician Practices, HIM, Information Systems, Patient Financial Services and Clinical Directors
- Works efficiently with minimal supervision
- Remains flexible to accommodate staffing shortages in the Patient Access department
Required Licenses/Certifications
- N/A
Working Conditions
- Works in a well-ventilated, well-lit general office environment
- Works well under pressure with attention to time constraints
ROUTINE RESPONSIBILITIES
Behavioral Expectations
- Consistently complies with established Behavioral Expectations
Essential Duties
- Verifies insurance eligibility and benefits directly with payer or on payer Website prior to starting the authorization process
- Identifies and documents each payer policy and procedure regarding coverage and items that require prior approval
- When applicable, verifies that Medicare diagnosis support service and frequency guidelines are not exceeded
- Manages daily work queues to ensure prior authorizations are submitted timely and accurately
- Ensures that notification of authorization approval or denial is communicated timely to the ordering physician’s office and to the patient
- Follows up with payers to check status of previously submitted prior authorizations
- Works directly with Director of Revenue Cycle to identify trends in denials and opportunities for improvement in the authorization process
- Implements a payer-specific check list for eligibility, benefits, and authorization to cover pre-financial clearance
Full time/Day shift
80 hours/Biweekly