ESSENTIAL FUNCTIONS
- Monitors the authorizations of upcoming surgical cases on the physician’s calendars ensuring authorizations for surgeries are obtained in a timely and accurate manner.
· Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms necessary information to allow processing of claims to insurance plans.
· Accurately completes surgical cost analysis form, documenting the required surgical cost estimation for collection prior to services.
· Verifies benefits on all surgical procedures.
· Document authorizations and progress of authorizations in the patient’s chart. Enters the authorization information within case management.
· Must be able to communicate effectively with physicians, patients, and co-workers and be capable of establishing good working relationships with both internal and external customers.
· Participate in providing ongoing training and education of staff as it relates to new processes to ensure timely confirmation of surgical cases.
· Work with department manager to respond to and reduce complaints timely and professionally.
· Assist surgery schedulers with STAT authorizations.
· Ensure strict confidentiality of all health records, member information and meet HIPAA guidelines.
· Assists in identifying opportunities for improvement within the daily workflow process.
· Attends department meetings as required.
EDUCATION
- High school diploma/GED or equivalent working knowledge preferred.
EXPERIENCE
- A minimum of 2 years of experience in the healthcare field is required and previous experience in referrals/authorizations, front office, and/or charge posting is preferred.
· Excellent organizational skills and strong customer service orientation are required with a strong background in computers and data entry.
KNOWLEDGE
- Working knowledge of eligibility, verification of benefits, and prior authorizations from various HMOs, PPOs, commercial payers, and other funding sources.
- Federal, state, and HIPAA privacy regulations.
· Knowledge of computer applications.
SKILLS
- Skill in effective organization and billing requirements and authorization processes.
· Skill in using computer programs and applications including Microsoft Excel, Microsoft Word, and Outlook
· Skill in establishing good working relationships with both internal and external customers.
ABILITIES
- Ability to multi-task in a fast-paced environment. Must be detailed oriented with strong organizational skills.
· Ability to understand patient demographic information and determine insurance eligibility.
· Ability to work independently and demonstrate the ability to analyze data.
· Ability to communicate effectively and compassionately with patients, co-workers, management, and providers.
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