WINDSOR HTS, IA
Job Description:
? Provides accurate and complete data for patient enrollment and offers excellent customer service.
? Obtains prior authorizations for all insurance using payer-specific tools.
? Maintains a working knowledge of precertification requirements by payer, utilizing payer-specific websites.
? Reviews and analyzes clinical data for pre-authorization requests against medical diagnosis or CPT codes.
? Assists with the review process and necessary research of payers requesting additional information.
? Communicate with clinical staff and partners to obtain additional information required for authorization approval.
? Verify eligibility and benefits for each patient.
? Responsible for entering detailed notes in the Electronic Medical Record (EMR) that pertain to patient intake, referrals, and authorizations.
? Identifies opportunities for process improvement.
? Participates in continuing education and professional development.
? Maintains a working knowledge of all revenue cycle management computer systems and Electronic Medical Record (EMR) .
? Understands company processes, procedures, and policies and ensures adherence to company guidelines.
? Performs other duties as assigned.
Required Experience
? Minimum Experience: Some prior authorization experience.
? Working knowledge of medical terminology, insurance terminology, and pre-certification guidelines.
? Basic knowledge of medical clinic operating policies and procedures.
? Knowledge of insurance agency reimbursement procedures and practices.
? Knowledge and understanding of HIPAA guidelines and commitment to maintaining the highest level of confidentiality and adherence to HIPAA regulations.
? Skilled in using computer programs and applications.
? Skilled in typing a minimum of 50 WPM.
? Skilled in using a calculator and basic math.
? Ability to read, understand, and follow oral and written instructions.
? Ability to multi-task.
? Ability to communicate effectively.
? Ability to analyze information and provide a solution.
? Ability to handle pressure, heavy workload, and meet deadlines.
? Ability to sort and file materials correctly by alphabetic or numeric systems.
? High School diploma or equivalent. Associate degree preferred.
? Certifications in prior authorization, billing, and reimbursement are highly desirable, including but not limited to:
o Certified Revenue Cycle Specialist (CRCS) from the American Association of Healthcare Administrative Management (AAHAM).
o Certified Revenue Cycle Representative (CRCR)
o Certified Medical Reimbursement Specialist (CMRS) from the American Medical Billing Association (AMBA).
o Certified Healthcare Access Associate (CHAA) from the National Association of Healthcare Access Management (NAHAM).
This is a remote position.