JOB TITLE: Pre-Authorization Coordinator
GENERAL SUMMARY OF DUTIES: Responsible for obtaining insurance Company pre-authorizations for tests/procedures and for nuclear stress test scheduling oversight
SUPERVISION RECEIVED: Reports to Patient Accounts Manager
SUPERVISION EXERCISED: None
ESSENTIAL FUNCTIONS:
Coordinate with health insurance representatives, patients, and MCA physicians/staff the information required to obtain pre-authorizations
Copy and forward medical chart documentation to health plan representatives
Constantly monitor and remain current with full testing schedule
Monitor tasking workflow report to obtain referrals that require authorizations
Verify patient insurance and demographic information using all available means
Consult with physicians, nurses, and staff regarding the pre-authorization process
Maintain referral and pre-authorization records and files documentation
Respond to patient inquiries regarding their health plan benefits guidelines
Assist with referral audits and special projects as directed
Gather and report referral and claim information and trouble-shoot insurance problems and claims
Perform other duties as assigned
EDUCATION: High School Diploma or GED required.
EXPERIENCE Minimum of two years managed care experience in claims and customer service required
REQUIREMENTS: Must have Pre-Authorization experience to be considered. Strong medical terminology. Adherence to all policies and procedures, including confidentiality, safety, performance, attendance, punctuality, and personal grooming and appearance. Ability to read, understand, and follow oral and written instructions. Ability to speak and write in a professional, courteous, and concise manner. Accept and utilize feedback and constructive criticism.
SKILLS:
Excellent interpersonal, typing, and organizational skills
Excellent use of computers, printers, telephones, fax machines, and other office equipment
Ability to multi-task, be detail oriented, problem solve, and prioritize responsibilities
Work well both independently and as a team member
Demonstrate efficient use of time and ensure work is accurate and of high quality
Establish and maintain effective working relationships with patients, colleagues, physicians, and the public
Successfully manage interactions with challenging or difficult people
PHYSICAL/MENTAL DEMANDS: Requires prolonged sitting; standing; walking; hand dexterity for telephone, computer and equipment use; and normal vision, speaking, and hearing.
ENVIRONMENTAL WORKING CONDITIONS: Medical office environment. Work may be stressful at times. Interaction with others is constant and interruptive.
This description is intended to provide only basic guidelines for meeting job requirements. Essential functions, education, experience, requirements, skills, physical/mental demands, and working conditions may change as needs
change.