Job Details
Job Location: Caldwell Medical Center - PRINCETON, KY 42445
POSITION SUMMARY
This position is responsible for obtaining pre-certifications and pre-authorizations for procedures and medications, scheduling appointments for outpatient testing with our providers, transcribes and triages patient calls to physicians, coordinates patient appointments/orders.
KEY RESPONSIBILITIES
- Review chart documentation to ensure patient meets medical policy guidelines.
- Prioritize incoming authorization requests according to urgency.
- Obtain authorization via payer files to include up to date requirements needed to successfully to obtain authorizations
- Initiate appeals for denied authorizations
- Respond to clinic questions regarding payer medical policy guidelines.
- Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
- Contact patients to discuss authorization status
- Other duties as assigned
- 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 and follow up and secure prior-authorizations prior to services being preformed
- Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations
- Communicate any insurance changes or trends among them
- Maintains a level of productivity suitable for the department
- Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.
- Other duties as assigned
Qualifications
MINIMUM EDUCATION
- High School Diploma or GED
PREFERRED EDUCATION
- Knowledge of medical terminology
- Familiarity with different insurance types
MINIMUM EXPERIENCE
- 1 year experience in a medical related field required
- Previous experience in a clinic setting
PREFERRED EDUCATION
- 1 Year pre-certification or pre-authorization experience preferred