Eligibility Program Counselor

JOB SUMMARY

The Prior Authorization Coordinator will be responsible for performing all tasks regarding obtaining prior approvals from payers for our client’s services. • Review chart documentation to ensure patient meets medical policy guidelines. • Prioritize incoming authorization requests according to urgency. • Obtain authorization via payer website or by phone and follow up regularly on pending cases. • Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations. • Initiate appeals for denied authorizations. • Respond to clinic questions regarding payer medical policy guidelines. • Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order. • Contact patients to discuss authorization status and scan all documentation into patient’s chart. • Comply with HIPAA compliance policies.

JOB QUALIFICATIONS

Education:  Completion of a high school diploma required.  College level courses preferred.

Licensure:  Certified Revenue Cycle Representative (CRCR) or Certified Healthcare Access Associate (CHAA) preferred.

Experience:  At least 4 years of experience in a patient financial healthcare setting, along with in depth knowledge of health insurance                     plans and understanding of HIPPA regulations required.

Skills: Excellent oral and written communication skills in order to effectively interact with internal and external customers.  Job duties and tasks are frequently non-routine which requires logical problem solving ability.  Ability to interpret and follow oral and written instructions, policies, guidelines and standards.  Ability to use good judgment in the absence of formal guidelines, policies or procedures.  Ability to prioritize and manage time effectively.  Working knowledge of medical A/R software programs and intermediate PC skills including Microsoft Outlook, Word and Excel.  Must be detail oriented and able to demonstrate competence in basic math concepts.

Full-Time Benefits

• 403(b) Matching (Retirement)

• Dental insurance

• Employee assistance program (EAP)

• Employee wellness program

• Employer paid Life and AD&D insurance

• Employer paid Short and Long-Term Disability

• Flexible Spending Accounts

• ICHRA for health insurance

• Paid Annual Leave (Time off)

• Vision insurance