Prior Authorization Coord

Brown University Health · Providence, RI · 3 wk ago

OTHR$19.03–$31.39/hrFull-time

Registers patients prior to scheduled appointments to obtain updated account information for accurate insurance billing.
Confirms patient eligibility with insurance carriers/third party payors and obtains pre-authorization requirements in accordance with established medical policies.
Captures and reviews clinical documentation from patient records pertinent to obtaining prior authorization as necessary.
Analyzes orders, authorizations, and records for discrepancies that may affect insurance coverage and/or denial of claims.
Notifies and coordinates with ordering physicians and providers when peer-to-peer discussions are required to obtain prior authorization of services being denied by patients’ insurance.
Communicates professionally with various Brown University Health personnel to resolve billing issues, authorization denials, and financial clearance of patient appointments.
Ensures all patients are financially cleared by insurance/third party payor prior to their scheduled appointments.

A high school diploma or equivalent is required.
Knowledge of business systems, office procedures, computer skills, medical terminology, and health insurance processes/terminology including, but not limited to, CPT and ICD-10 coding.
Strong organizational skills, critical thinking, and focus to detail are required to manage high volume of radiologic orders requiring prior authorization and/or financial clearance.
Analytical skills to evaluate effectiveness of work flow with the ability to make recommendations, develop, and adapt to changes as necessary.
Interpersonal skills necessary to provide effective communication with patients and other healthcare professionals within and outside of Brown University Health.

Two years of previous experience in health care environment with emphasis in health insurance billing and reimbursement, healthcare operations, database management, and patient/provider interaction.

Normal office environment; may experience some visual fatigue as a result of extended periods of work on the computer.

Performs independently within the department’s policies and practices. Refers specific complex problems to the supervisor when clarification of the departmental policies and procedures are required.

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