Job Description

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JOB SUMMARY:

Under general supervision, utilizes independent judgment and skills to preauthorize physician services, ancillary services, surgical procedures, and other related medical, therapeutic and diagnostic services. Responsible for maintaining accurate and most recent guidelines of third party payors, government payors and managed care companies required to preauthorize medical services successfully.

EDUCATION/EXPERIENCE:

High school diploma or GED equivalent with two years of clerical experience with an understanding of medical insurance and preauthorization required. Medical office or insurance experience required. Knowledge of medical terminology, managed care experience, and knowledge of ICD-CM9 and CPT coding preferred.

ESSENTIAL FUNCTIONS: * Collects and organizes patient demographic information required to preauthorize medical services.

• Obtains authorization and documents specific services authorized, expiration date and other relevant information.
• Establishes and maintains contacts and cooperative working relationships with payor representatives.
• Obtains and comprehends new payor contracts to enable informed communication and timely preauthorization.
• Reviews accounts to determine need for re-certification.
• Prepares and mails treatment progress notes, plans, goals and guidelines as requested by payors.
• Provides general information and answers to inquiries concerning preauthorization processes.
• Acts as a liaison with various agencies to advise patients regarding coverage preauthorization.
• Interacts directly with patients by telephone or in person to inform of preauthorization requirements and confirm coverage.
• Interacts with other clinic staff to facilitate accurate, comprehensive and timely preauthorization of services.
• Maintains patient charts, related files, correspondence, and up-to-date payor contracts.
• Updates and trains reception staff through in services and memorandum on new contracts and requirements of clinical staff.
• Prepares statistical reports as requested by management.
• Performs other duties incidental to the work described herein.

SKILLS/QUALIFICATIONS:

• Ability to perform multiple tasks simultaneously
• Strong computer experience

About Us:

Atrium Health Wake Forest Baptist is a pre-eminent academic health system based in Winston-Salem, North Carolina. Atrium Health Wake Forest Baptist is part of Advocate Health, which is headquartered in Charlotte, North Carolina, and is the fifth-largest nonprofit health system in the United States, created from the combination of Atrium Health and Advocate Aurora Health. Atrium Health Wake Forest Baptist\'s two main components are an integrated clinical system - anchored by Atrium Health Wake Forest Baptist Medical Center, an 885-bed tertiary-care hospital in Winston-Salem - that includes Brenner Children\'s Hospital, five community hospitals, more than 300 primary and specialty care locations and more than 2,700 physicians; and Wake Forest School of Medicine, the academic core of Atrium Health Enterprise and a recognized leader in experiential medical education and groundbreaking research that includes Wake Forest Innovations, a commercialization enterprise focused on advancing health care through new medical technologies and biomedical discovery.

Wake Forest Baptist Health, Wake Forest University School of Medicine and Atrium Health have joined forces in a strategic combination that will enhance care, transform medical education and create economic opportunity for countless lives in North Carolina and beyond. As a part of that combination, the two health systems will be integrating technology and platforms, including our career sites.

This means that although you are applying on the Wake Forest Baptist Health Career Site, you receive communications from the Atrium Health Recruitment Team. Please know that this is an expected process, and thanks in advance for your flexibility.

About the Team:

Mission, Vision and Culture Commitments

Mission

To improve health, elevate hope and advance healing - for all.

Vision

To be the first and best choice for care.

Culture Commitments

We create a space where all Belong

We Work as One to make great things happen

We earn Trust in all we do

We Innovate to better the now and create the future

We drive for Excellence - always

Wake Forest Baptist Health