POSITION SUMMARY

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Must be available from the hours of 8 am-5 pm CT Monday – Friday
• Manage correspondence with insurance companies, physicians, specialists and patients as needed, including documenting in the EHR as appropriate
• Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
• Review accuracy and completeness of information requested and ensure that all supporting documents are present
• Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial
• Receive requests for prior authorizations through the electronic health record (EHR) and/or via phone or fax and ensure that they are properly and closely monitored
• Using knowledge of required authorizations, maintain tracker of all procedures requiring auth and pertinent details
• Ability to use portals to verify active insurance and coverage types, determining patient responsibility and OOP
• Follow up on missing or inaccurate information including coordination with clinical staff and physicians as well as all referrals to ensure no care gaps
• Ensure authorizations are available prior to patient appointments and in patient chart
• Ability to maintain good relationships with patients, providers and coworkers
• Communicate patient’s financial obligations if applicable
• Update demographic information as necessary
• Informs appropriate staff/patient of authorizations/referral requirements
• Staying current with insurance requirements, maintaining trackers with denied claims and problem solving as applicable
• Comply with corporate policies, goals and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment
• Ability to work hand in hand with 3rd party RCM company