Preauthorization Representative - Orthopedics - Sharon Hospital - Sharon, CT

Description

Title: Preauthorization Representative - Orthopedics - Sharon Hospital - Sharon, CT Full time - Monday-Friday 8:30am -5:00pm

Summary:

Facilitates patient flow through the pre-registration process, including scheduling, prior authorization, benefits investigation and financial clearance for NHMP medical practice medications. Answers incoming phones calls in a timely manner with excellent customer service to patients and referring physicians. Responsible for obtaining demographic and financial information to ensure accurate patient identification, identify, and secure appropriate payment sources. Performs pre-registration functions and insurance eligibility verification.

Responsibilities:

 1. Serves as the coordinator for prior authorization of all in office medications and infusions as directed by clinicians.

2. May be assigned to register, schedule patients and answer all incoming phone calls in a timely manner. Provides excellent customer service to both physicians and patients.

3. Serves as a liaison with clinicians, scheduling and clinical staff regarding patient authorizations.

4. Communicates with insurance providers about the patients medical necessity and obtains authorization for needed authorizations 5. Ensures that proper selection of insurance, plan type, prioritization, pre-certification and billing address are assigned in the system utilizing a broad knowledge of insurance as well as regulatory and contractual compliance.

6. Responsible for the collection of co-payments and past due balances when necessary.

7. Facilitates in gathering accurate patient billing information.

8. Performs insurance eligibility verification and executes payer requirements as needed. Includes initiating eligibility transactions via the Internet, contacting the payer to obtain billing information and authorization and scripts for service when appropriate.

9. Initiates requests for authorizations, prior authorizations, and referrals from insurance companies. Utilizes Electronic Medical Record (EMR) system to obtain necessary clinical information to secure such prior authorization. Follows up with payers to ensure that authorizations are in place prior to time of service. Takes appropriate steps to remediate situations in which financial clearance is not completed prior to time of service to ensure that WCHN (hospitals and medical group) receive prompt payment for services rendered.

10. Responds to telephone calls according to established customer service standards. Provides requested information to callers. May initiate contact to patients to obtain additional information or confirm scheduled appointments.

11. Fulfills all compliance responsibilities related to the position.

12. Maintain and Model Nuvance Health Foundational Values (Personal, Imaginative, Agile, Connected).

13. Performs other duties as required.

Education Skills Experience:

Required: Data entry, MS Word and MS Excel required

High school diploma or GED

Minimum Experience: seven years or more

Other Information:

Required: Data entry, MS Word and MS Excel required

High school diploma or GED

Minimum Experience: seven years or more

Salary Range: $18.13 - $34.50 Hourly