Prior Authorization Rep

QUALIFICATIONS Education High school diploma or equivalent Associate degree preferred Experience/Skills Has one year patient access, medical billing, or prior authorization experience Possesses medical terminology and CPT/HCPCS/ICD-10 coding knowledge Demonstrates proficiency in Meditech and MS Excel Professionally collaborates with staff at various levels throughout the organization, including, but not limited to: Physician Practices, HIM, Information Systems, Patient Financial Services and Clinical Directors Works efficiently with minimal supervision Remains flexible to accommodate staffing shortages in the Patient Access department Required Licenses/Certifications N/A Working Conditions Works in a well-ventilated, well-lit general office environment Works well under pressure with attention to time constraints ROUTINE RESPONSIBILITIES Behavioral Expectations Consistently complies with established Behavioral Expectations

Verifies insurance eligibility and benefits directly with payer or on payer Website prior to starting the authorization process Identifies and documents each payer policy and procedure regarding coverage and items that require prior approval When applicable, verifies that Medicare diagnosis support service and frequency guidelines are not exceeded Manages daily work queues to ensure prior authorizations are submitted timely and accurately Ensures that notification of authorization approval or denial is communicated timely to the ordering physician’s office and to the patient Follows up with payers to check status of previously submitted prior authorizations Works directly with Director of Revenue Cycle to identify trends in denials and opportunities for improvement in the authorization process Implements a payer-specific check list for eligibility, benefits, and authorization to cover pre-financial clearance Full time/Day shift 80 hours/Biweekly