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.