Prior Authorization Coordinator

GENERAL SUMMARY OF DUTIES

Responsible for verification of insurance benefits and obtaining pre-certifications and authorizations on all New Patients, Infusions, MRI Procedures and any other office procedures that may require pre-certification.

SUPERVISION RECEIVED

Office Manager

ESSENTIAL FUNCTIONS

• Processes insurance verification in a timely manner.
• Prepares insurance forms and associated correspondence as needed.
• Affords patients in preparing insurance forms.
• Make patients aware of their financial responsibility after insurance benefits have been determined.
• Follow up on claims to insure that insurance companies have paid according to agreement and as verified.
• Maintains files with insurance authorization and referral slips.
• Maintains strict confidentiality required related to medical records and other data.
• Schedule all infusion referrals.

EDUCATION

High school graduation or GED. Associate degree in business administration or secretarial program preferred.

EXPERIENCE

Minimum of three years experience with handling insurance verification and obtaining information on patients’ insurance benefits.

KNOWLEDGE

• Knowledge of clinic policies and procedures.
• Knowledge of medical terminology and insurance practices.
• Knowledge of computer programs and applications.
• Knowledge of grammar, spelling and punctuation to type correspondence.

SKILLS

• Skill in gathering, interpreting and reporting insurance information.
• Skill in trouble-shooting insurance problems and claims.
• Skill in written and verbal communication.

ABILITIES

• Ability to identify claim problems and recommend solutions.
• Ability to sort and file insurance forms and associated information.
• Ability to work with effectively with patients, employees and the public.

PHYSICAL/MENTAL DEMANDS

Work requires hand dexterity for office machine operation, stooping and bending to files and supplies, mobility to complete errands, or sitting for extended periods of time.

ENVIRONMENTAL/WORKING CONDITIONS

Normal office environment. May view computer screens for long periods of time. Occasional evening or weekend work.