Prior Authorization Clerk - Artesia General Hospital : Job Details

Job Summary:

Primarily responsible for providing effective leadership and customer service for Patient Access employees as well as internal and external customers by utilizing excellent, in-depth knowledge of hospital admissions and outpatient services.

ESSENTIAL FUNCTIONS:

* Initiates and process prior authorization requests from healthcare providers for medical procedures and surgical services.

* Verify patient insurance coverage and benefits to determine requirements for prior authorization and collaborate with Artesia General providers, insurance companies, and patients to facilitate efficient authorization processes.

* Maintain accurate records of authorization requests, approvals and denials

* Communicate with providers and front-end office, insurance companies, and patients regarding authorization status, requirements and appeals.

* Prepare and submit prior-authorization appeal requests as necessary

* Communicates with patients their copay, out-of-pocket, co-insurance and deductible amounts.

* Familiarity with insurance plans, authorization processes and coverage policies

* Accurate data entry and record keeping.

KNOWLEDGE/SKILL/ABILITIES:

* Proficiency in using electronic medical records systems

* Understanding medical terminology, procedures, and healthcare regulations

* Clear and effective communication and verbal skills

* Accurate data entry and record keeping

* Ability to resolve issues related to authorization request and denials.

* Ability to work independently and professionally.

EDUCATION AND EXPERIENCE

* High School Diploma and or GED

* Previous experience in healthcare medical billing and insurance authorization, preferred

* Ability to work overtime to meet deadlines or handle urgent authorization request.

AGE-RELATED COMPETENCIES: Demonstrates the basic knowledge and skills (cognitive, technical and interpersonal) necessary to identify age-specific patient needs appropriate for all age groups.

Information Management: Treats all information and data within the scope of the position with appropriate confidentiality and security.

Risk Management/Quality Management/Safety: Cooperates fully in all Risk Management, Quality Management, and Safety Activities and Investigations.

MINIMUM POSITION QUALIFICATIONS:

* Education - High School Diploma

* Work Experience - Customer service experience preferred, good communication skills required, bi-lingual capabilities preferred. Minimum of one year of prior authorization experience preferred.

* Training - N/A

* License/Certification - N/A

ENVIROMENTAL CONDITIONS: Work environment consists of daily patient contact, which may include exposure to blood, or other body fluids.