Memorial Hospital At Gulfport

Job Description

Job Description:

Obtains, verifies, and assists in the completion of authorization

Monitors a listing of scheduled procedures to begin and complete the authorization process

Reviews clinical records for supporting documentation and submits to obtain authorization

Documents accounts and charts with updated authorization statuses based on final payer responses

Completes authorizations with no more than five incomplete authorizations within a one-year period

Receives communication from providers and/or the provider’s staff when procedures are ordered for outside facilities

Acts as a liaison with physician offices, insurance companies, and utilization review companies

Reports denials and works with providers to appeal as the providers sees fit

Gathers information requested by providers and assists by prefilling forms

Communicates with providers regarding incomplete documentation, peer-to-peer review requests, denials and appeals

Works in conjunction with billing departments to obtain authorizations post service initiation

Examines past procedures for performed testing with missing authorizations

Submits clinical documentation for retroactive or upgraded authorizations

Collaborates with billing to obtain authorization when denials or audits are necessary due to final payer response

Required Qualifications:

Education: High School Diploma or GED equivalent.

Experience: Two (2) years of experience with precertification and insurance verification in a hospital or healthcare setting OR completion of LPN/RN program.

Responsibilities

Job Description:

• Obtains, verifies, and assists in the completion of authorization
  • Monitors a listing of scheduled procedures to begin and complete the authorization process
  • Reviews clinical records for supporting documentation and submits to obtain authorization
  • Documents accounts and charts with updated authorization statuses based on final payer responses
  • Completes authorizations with no more than five incomplete authorizations within a one-year period
  • Receives communication from providers and/or the provider’s staff when procedures are ordered for outside facilities
• Acts as a liaison with physician offices, insurance companies, and utilization review companies
  • Reports denials and works with providers to appeal as the providers sees fit
  • Gathers information requested by providers and assists by prefilling forms
  • Communicates with providers regarding incomplete documentation, peer-to-peer review requests, denials and appeals
• Works in conjunction with billing departments to obtain authorizations post service initiation
  • Examines past procedures for performed testing with missing authorizations
  • Submits clinical documentation for retroactive or upgraded authorizations
  • Collaborates with billing to obtain authorization when denials or audits are necessary due to final payer response

Qualifications

Required Qualifications:

Education: High School Diploma or GED equivalent.

Experience: Two (2) years of experience with precertification and insurance verification in a hospital or healthcare setting OR completion of LPN/RN program.