Bryan Heart Pre-Authorization Specialist

Principal Job Functions

• Commits to the mission, vision, beliefs and consistently demonstrates our core values.
• Assembles information concerning patient’s clinical background and presents appropriate and necessary information to payer authorization representatives.
• Obtains authorizations for services ordered for all payers (Medicare, Medicaid, and commercial plans) that require authorization.
• Works closely with business office team (coders and billers) to ensure accurate procedure and diagnosis codes are being utilized in the pre authorization process.
• Completes all requests for authorizations received in a timely manner.
• Accurately and completely documents all actions taken regarding the pre authorization process including documenting the pre authorization number/code in the appropriate tracking system (Practice Management).
• Remains current with all pre authorization guidelines specific to all payers and informs staff and clinic administration as necessary.
• Provides effective communication, proactively and in response, to patients/family members, team members, physicians and other healthcare providers while maintaining confidentiality.
• Prepares and provides patients with an estimate, if one is warranted, for their expected services and/or connects the patient/guarantor to the estimates team.
• Establish and maintain relationships with cultural and community resources relating to assistance with patient experiencing financial difficulty or cost concerns.
• Attends appropriate workshops to enhance pre authorization skills and payer guidelines.
• Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.
• Participates in meetings, committees and department projects as assigned.
• Performs other related projects and duties as assigned.

Education And Experience

• High School diploma or equivalency required.
• Certified Medical Assistant or Licensed Practical Nurse preferred.
• Minimum of one (1) year work experience in a medical office setting required.
• Prior pre-authorization, coding or medical billing experience preferred.