JOB SUMMARY: Verifies inpatient/observation authorizations have been requested. Follows up with Case Management in regards to appropriate documentation sent to insurance company. Works outpatient surgery, outpatient testing and inpatient schedules surgery list to verify benefits and authorization has been completed. Main contact for referring physician regarding authorization requested from insurance. Works closely with registration staff, surgery scheduling staff, imaging scheduling staff, case management staff and business office staff on issues regarding authorizations.
EDUCATION, EXPERIENCE, TRAINING
1. Minimum 2 years authorization experiences in hospital setting preferred; insurance verification experience required.
2. Knowledge of insurance requirements for authorizations.
3. Knowledge of medical terminology.
4. Effective written and verbal communication skills.
5. Ability to multi-task, prioritize needs to meet required timelines.
6. Analytical and problem-solving skills.
7. Customer Services experience required.
8. High School Graduate or GED equivalent required.
DUTIES AND RESPONSIBILITIES
1. Initiate front registration inpatient authorization request.
2. Follow up authorization requests from Emergency Department.
3. Establish, implement and train all staff on authorizations.
4. Work with case management, scheduling registration and business office with needs for authorizations or issues with authorizations.
5. Establish and maintain prior authorizations list by payor and service line.
6. Establish, maintain and report to Director authorizations requested, authorizations denied and authorizations approved.
7. Provide education to staff as necessary with regards to authorizations.
8. Work CRC report for any missing information.
9. Maintains regular attendance.
10. Performs other duties as assigned or required.
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