Preauthorization Associate

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


Responsibilities:

  1. Answer calls/requests from physician offices, providers, insurance companies, and patients using exemplary customer service skills.
  2. Follow the appropriate procedure when an authorization request is received
  3. Verification of insurance eligibility
  4. Create/update patient accounts with accurate demographic and appointment information.
  5. Maintain patient confidentiality and patient privacy standards.
  6. Determine authorization requirements based in specific insurance carrier rules.
  7. Review and obtain patient clinical information from providers or previous medical history.
  8. Initiate and follow through on the authorization process. Submit requested clinical information to insurance carriers during the review process if needed.
  9. Approval information to be enterd into the appropriate electronic databases.
  10. The appointment information is updated with accurate authorization details and forwarded to the respective referring physician.
  11. Contact the patient to schedule the appointment and provide any relevant instructions or preparations for the specific study.
  12. Follow the appropriate procedure when an authorization request is denied.
  13. Effectively communicate the denial information to the referring physician and/or patient.
  14. Contact insurance carrier to discuss review options such as appeal, reconsideration, or peer to peer review.
  15. Peer to peer reviews will be set up based on referring physician schedule.
  16. Follow through until the review process is complete.
  17. Effectively communicate review decision with referring physician and/or patient.
  18. Manage day to day responsibilities
  19. Periodic review of daily schedule for add-on and emergent, same day studies.
  20. Monitoring of incoming fax and email requests.
  21. Effectively communicate with the Director of Operations and Monroe Clinical Operations Manager
  22. Provide periodic updates to the Director of Operations
  23. Communicate any customer experience issues or concerns to management.


Qualifications:

  • 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.



Job Requirements:

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