Pre-Authorization Specialist- Part Time

Schedule

Monday-Friday 8a-12p or 1p-5p. 20 hours/week

Major Responsibilities & Duties

• Maintains excellent communication and positive rapport with all points of contact both internally and externally, documenting pertinent discussions and details of correspondence in all applicable systems to provide tracking and point of reference.
• Responsible for obtaining and communicating accurate benefit information and eligibility, pre-determination/pre-authorization as well as detailed benefit and patient liabilities per insurance company requirements and established timeframes, i.e., online vs. telephone to ensure credible coverage and benefits are in place.
• Responsible for monitoring incoming additions, revisions and cancellations as well as clinical requests for authorization and benefit identification.
• Practice includes; printing scheduled procedures from the Surgery Information System, assigning self to work case and identifying any need to contact patient to obtain additional registration or demographic information, as well as determining any change to authorization and/or coverage requirements.
• Routinely monitors cases pending or not yet started/complete which are a minimum of 1 month (4 weeks) out from scheduled date of service and initiates authorization/determination/eligibility process being attentive to payer specific processing time frames or clinical documentation needs.
• Obtains the necessary CPT, HCPC and Diagnosis codes as needed through utilization of coding resource materials, or through Supervisor or Coding Department assistance. When Codes are provided through community Provider office, will validate agreement of codes through internal practice and work with servicing provider to address any variance in findings.
• Initiates expedited reviews with payers when necessary to ensure authorization is in place prior to, or at the time of service and communicates late notifications or risk of no auth situations to Supervisor as soon as identified.
• Identifies and takes steps to ascertain and provide necessary clinical documentation to meet payer requests as needed for authorization or pre-determination needs.
• Responsible for data entry of documentation on patient accounts in the computer system, including completion of a surgery admission packet, financial disclosure and necessary admission forms.
• Communicates in a positive and professional manner with the patient / guarantor on any financial issues, including assisting with Financial Assistance application or referrals, accepting of required down payments and setting up acceptable payment plan agreements.

Knowledge, Skills, and Abilities

• Knowledge of insurance terms, reimbursement procedures, rates and policies related to medical terminology.
• Ability to give attention to detail and follow established standards and procedures.
• Knowledge of Explanation of Benefits (EOB), CPT, HCPC and Diagnosis Codes.
• Must have excellent verbal/ written communication skills to communicate effectively with physicians, patients and families.
• Knowledge of telephone etiquette required.
• Ability to handle multiple tasks at a time.
• Detail oriented.
• Knowledge of insurance terms and reimbursement procedures.

Required Qualifications

• High school diploma or equivalent required.

Preferred Qualifications

• Minimum of 2 years' experience working in a hospital or clinic billing environment, preferably focused on registration, billing and/or preauthorization preferred.

Other Duties

This job description incorporates the essential functions and duties required for this position. However, other duties may be required and assigned at times and as determined by a supervisor in order to meet the needs of the organization. Serves as a role model in carrying out activities and behaviors that reflect the values and principles of the Boys Town mission.

Physical Requirements, Equipment Usage, Work Environment

Position is relatively sedentary in a normal office administrative environment involving minimum exposure to physical risks. Will use office equipment such as a computer/laptop, monitor, keyboard, and a general workstation set-up.