Reports to the VP Patient Access, responsibilities include evaluating designated referred services for authorization needs based on government and commercial payor requirements. Disseminates all clinical and coding supporting documentation to effectively complete the authorization process to ensure appropriate reimbursement.
This position provides exceptional customer service during every encounter with patients, families, visitors, and associates by communicating with empathy and clarity regarding the details of the next step in care.
Duties:
- Serve as primary contact and resource for all designated prior authorization needs.
- Identify, collect, and coordinate clinical documentation to support the qualification of ordered services.
- Evaluate orders for insurance coverage and authorization requirements.
- Ensure carrier process requirements are met within contracted guidelines and timeliness.
- Validate completed authorizations to ensure correspondence with ordered service, code, time frame, and provider.
- Support the appeal process by communicating and coordinating resolution expectations with provider and authorization agent.
- Maintain standardized records for effective coordination, tracking, and reporting.
- Advocate for customers by recognizing when to dispute non-desirable outcomes regarding prior authorization.
- Dispute and negotiate when necessary to ensure positive prior authorization outcomes.
- Provide exceptional customer-centric service at every encounter.
- Use critical thinking to make decisions, identify problems, create solutions, and escalate concerns when necessary.
- Participate in performance improvement and follow established work systems.
- Prioritize work effectively and maintain accuracy in a fast-paced environment.
- Use multiple software platforms (EMRs, insurance websites, referral databases, scheduling software) to conduct tasks for patient care.
Additional duties:
- Assist others and accept additional duties as needed.
- Enhance professional growth through in-service meetings and education.
- Maintain up-to-date knowledge of insurance, department, and process changes.
Requirements:
- Associate's Degree in Business or Health Care related field with one year medical authorization or related experience, or high school diploma/equivalent with three years medical authorization or related experience.
- Preferred: Completion of an approved Medical Assistant Program with certification or equivalent medical office experience.
- Knowledge of medical terminology, ICD-10, CPT, prior authorizations, third party payors, and prior authorization processes.
- Working knowledge of Microsoft Office (Outlook, Excel, Word).
- Strong communication, analytical, organizational, and customer service skills.
- Ability to handle confidential patient information professionally.
Physical demands and working conditions:
- May need to travel between locations and work evenings.
- Requires sitting for long periods in front of a computer.
- Frequent exposure to noise and distractions.
Schedule:
- Full-time, Day shift, Monday to Friday 8:00 AM - 5:00 PM
Beacon Health System mission, values, and service goals emphasize outstanding care, trust, respect, integrity, compassion, and connecting personally with patients and families.
- Associate's Degree in Business or Healthcare related field with one year authorization experience, or high school diploma with three years authorization experience
- Medical Assistant certification or equivalent (preferred)
- Knowledge of medical terminology, ICD-10, CPT coding
- Familiarity with prior authorizations and insurance payors
- Proficient in Microsoft Office (Outlook, Excel, Word)
- Strong communication, analytical, customer service, and organizational skills
- Ability to handle confidential information professionally
Location
Indiana, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 week ago