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
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.
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