Employment Type: Full-Time
Industry: Healthcare - Nursing
PREAUTHORIZATION ASSOCIATE NEEDED FOR wonderful medical office in Monroe Township, NJ.
- To obtain imaging precertification requests and process while providing excellent customer service.
- Must be able to review structured clinical data and follow established compliance procedures.
- Must also be able to communicate effectively with internal and external contacts
- Answer calls/requests from physician offices, providers, insurance companies, and patients using exemplary customer service skills.
- Follow the appropriate procedure when an authorization request is received
- Verification of insurance eligibility
- Create/update patient accounts with accurate demographic and appointment information.
- Maintain patient confidentiality and patient privacy standards.
- Determine authorization requirements based in specific insurance carrier rules.
- Review and obtain patient clinical information from providers or previous medical history.
- Initiate and follow through on the authorization process. Submit requested clinical information to insurance carriers during the review process if needed.
- Approval information to be enterd into the appropriate electronic databases.
- The appointment information is updated with accurate authorization details and forwarded to the respective referring physician.
- Contact the patient to schedule the appointment and provide any relevant instructions or preparations for the specific study.
- Follow the appropriate procedure when an authorization request is denied.
- Effectively communicate the denial information to the referring physician and/or patient.
- Contact insurance carrier to discuss review options such as appeal, reconsideration, or peer to peer review.
- Peer to peer reviews will be set up based on referring physician schedule.
- Follow through until the review process is complete.
- Effectively communicate review decision with referring physician and/or patient.
- Manage day to day responsibilities
- Periodic review of daily schedule for add-on and emergent, same day studies.
- Monitoring of incoming fax and email requests.
- Effectively communicate with the Director of Operations and Monroe Clinical Operations Manager
- Provide periodic updates to the Director of Operations
- Communicate any customer experience issues or concerns to management.
- Previous experience in a team lead or management position.
- Previous experience in insurance verification/preauthorization
- Strong knowledge in clinical data and medical terminology.
- Ability to work effectively in an independent environment.
- Detail oriented with strong organizational skills.
- Self motivated with a desire to provide excellent customer service.
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