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POSITION SUMMARY: Responsible for collecting all the necessary documentation, contacting the client for additional information and completion of the required prior authorization order. Complete, timely and accurate identification and submission of prior and retro authorization requests to the payors. Interacts with patients, insurance companies and outside facilities as necessary to request prior authorizations. Responsible for coordination and processing of patient referrals for specialty services.
Position Qualification RequirementsEducation: Minimum High School graduate or equivalent. Graduate from an approved medical assisting or other health related program preferred.
Experience: Three (3) years' experience in a medical office, ambulatory care, or similar setting. Experience in medical billing/prior authorization/insurance is highly preferred.
Skills and Abilities which may be representative but not all inclusive of those commonly associated with this position:
Ability to communicate effectively with patients and staff in a professional, courteous, and effective manner.
Contributes to a positive work and team culture.
Must be computer literate with exceptional telephone skills.
Ability to read, writes, speak, and understand the English language fluently.
Possesses high job accuracy, efficiency, and dependability.
Results and goal-oriented with a philosophy for quality improvement.
Knowledge of HIPAA regulations, ICD-10, and CPT coding.
Knowledge in governmental and commercial payers, medical billing requirements and prior authorizations.
Ensure all pertinent medical documentation is accurate and present prior to authorization submission.
Verifies patient insurance coverage, eligibility, and benefits.
Works with departments and insurance companies to obtain the necessary pre certifications, authorizations and referrals for services ordered/scheduled.
Communicates with patients on a timely basis for all scheduling requirements and processes as such.
Maintains an approachable and appropriate attitude when interacting with all levels of personnel in a rapidly changing environment.
Enters all referral, hospital, outpatient, and other patient specialty health service authorizations into the computer system according to agency policies and procedures.
Ability to successfully navigate between multiple systems throughout the course of the workday this includes but is not limited to billing software, payer portals, and multiple EMRs.
Assist with processing STAT or Urgent referrals within the department.
Forwards referral documents to Medical Records or scans into EMR for inclusion into patient charts.
Receives consultant reports, maintains documentation, and routes to the appropriate physician promptly.
Performs other duties as assigned.
Marginal Functions
Assists providers in completing all medical documentation needed to provide referral services to patients.
Documents and updates the most effective method for authorizing referrals.
Supervises: None
NOTE: Affinia Healthcare is a Covid-19 Vaccine Mandated Employer. All employees of Affinia Healthcare are required to be vaccinated for Covid-19.NOTE: SMOKING IS PROHIBITED IN THE WORK ENVIRONMENTNOTE: ALL APPLICANTS MUST PROVIDE CONTACT INFORMATION FOR THREE REFERENCESAN EQUAL OPPORTUNITY SERVICES PROVIDED ON A NON-DISCRIMINATORY BASIS
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Health Care Provider
Industries
Hospitals and Health Care
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