Pre-Authorization Coordinator
JOB TITLE: Pre-Authorization Coordinator
GENERAL SUMMARY OF DUTIES: Responsible for obtaining insurance Company pre-authorizations for tests/procedures and for nuclear stress test scheduling oversight
SUPERVISION RECEIVED: Reports to Patient Accounts Manager
SUPERVISION EXERCISED: None
ESSENTIAL FUNCTIONS:
- Coordinate with health insurance representatives, patients, and MCA physicians/staff the information required to obtain pre-authorizations
- Copy and forward medical chart documentation to health plan representatives
- Constantly monitor and remain current with full testing schedule
- Monitor tasking workflow report to obtain referrals that require authorizations
- Verify patient insurance and demographic information using all available means
- Consult with physicians, nurses, and staff regarding the pre-authorization process
- Maintain referral and pre-authorization records and files documentation
- Respond to patient inquiries regarding their health plan benefits guidelines
- Assist with referral audits and special projects as directed
- Gather and report referral and claim information and trouble-shoot insurance problems and claims
- Perform other duties as assigned
EDUCATION: High School Diploma or GED required.
EXPERIENCE: Minimum of two years managed care experience in claims and customer service required
REQUIREMENTS: Strong medical terminology. Adherence to all policies and procedures, including confidentiality, safety, performance, attendance, punctuality, and personal grooming and appearance. Ability to read, understand, and follow oral and written instructions. Ability to speak and write in a professional, courteous, and concise manner. Accept and utilize feedback and constructive criticism.
SKILLS:
- Excellent interpersonal, typing, and organizational skills
- Excellent use of computers, printers, telephones, fax machines, and other office equipment
- Ability to multi-task, be detail oriented, problem solve, and prioritize responsibilities
- Work well both independently and as a team member
- Demonstrate efficient use of time and ensure work is accurate and of high quality
- Establish and maintain effective working relationships with patients, colleagues, physicians, and the public
- Successfully manage interactions with challenging or difficult people
PHYSICAL/MENTAL DEMANDS: Requires prolonged sitting; standing; walking; hand dexterity for telephone, computer and equipment use; and normal vision, speaking, and hearing.
ENVIRONMENTAL WORKING CONDITIONS: Medical office environment. Work may be stressful at times. Interaction with others is constant and interruptive.
This description is intended to provide only basic guidelines for meeting job requirements. Essential functions, education, experience, requirements, skills, physical/mental demands, and working conditions may change as needs change.