Job Details

POSITION SUMMARY:

Provide clinical and clerical support to patients and clinic staff by handling medication and procedure prior authorizations for our medical practice as well as our ambulatory surgery center. 

PRIMARY JOB DUTIES:

• Receive requests for pre-authorizations and ensure that they are properly and closely monitored
• Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
• Follow prior authorization work flow, policies and procedures
• Collaborate with other departments to assist in obtaining pre-authorizations in a cross functional manner
• Review accuracy and completeness of information requested and ensure that all supporting documents are present
• Process referrals and submit medical records to insurance carriers to expedite prior authorization processes
• Manage correspondence with insurance companies, physicians, specialists and patients as required
• Create patients` records and accounts and ensure that pre-authorization information is properly updated in them
• Compare demographic, insurance clinical information, and supporting clinical documentation to validate accuracy of Prior Authorization before it is submitting to Insurance
• Answering and addressing the issues reported on the nurse line before end of day
• Input medical messages and call patient's with response
• Scan documents and attach to patient's demographics
• Ensures accurate and timely communication with patients, providers and other staff
• Additional duties as assigned

SKILLS:

• Ability to read and comprehend simple instructions, short correspondence, and Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
• Experience with Prior Authorizations on the medical/clinical side

COMPETENCIES:

• Exemplifies excellent customer service with patients, visitors, and other employees; shows courtesy, friendliness, helpfulness, and respect.
• Consistently demonstrates respect for the capabilities, different cultures and/or personalities of internal and external customers.
• Relates well, and works collaboratively with, all levels of staff in a professional manner.
• Consistently alters plans/routines when situation requires and continues to perform without projecting stress/frustration that would adversely affect the work environment.
• Maintains and ensures patient privacy and confidentiality.
• Performs other duties as assigned.
• Excellent Customer Service skills