Pre-Authorization Rep

Overview

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values—integrity, patient-centered, respect, accountability, and compassion—must guide what we do, as individuals and professionals, every day.

Under the direction of the SBO Manager- Greenwich, performs a wide variety of duties including technical and clerical support for the Pre-Reg/Pre-Auth Department. Primary duty is to obtain prior authorization of scheduled procedures to provide effective Customer Service while insuring optimal hospital reimbursement. Some traveling to the Main Hospital or training facilities may be required.

EEO/AA/Disability/Veteran

Responsibilities

  • 1. Answer calls from physicians offices and patients using exemplary customer service skills.
  • 2. Contact review organizations and insurance companies to ensure prior authorization requirements are met. Present necessary medical information such as history, diagnosis and prognosis. Provide specific medical information to financial services to maximize reimbursement to the Hospital & Physicians.
  • 3. Accurately enter required work queue information (non-clinical and structured clinical data) into EPIC
  • 4. Review structured clinical data matching it against specified medical terms and diagnoses or procedure codes (without the need for interpretation) and follow established procedures for authorizing request or referring request for further review to meet medical necessity.
  • 5. Attach incoming information to the scheduled procedure in EPIC and follow established procedures for distributing information for further review.
  • 6. Be the system navigator and point of contact for patients, families & physicians office's, with patient and physicians having direct access for asking questions and raising concerns. May assume the patient advocate role on the patients' behalf with carrier to ensure approval of the necessary services for the patient in a timely fashion.
  • 7. Call back providers with pre-authorization numbers as needed, and file precertification requests as per established guidelines.
  • 8. Print and send form letters as needed
  • 9. Performs other related duties, assignments and responsibilities as assigned or required.

Qualifications

EDUCATION

 

High School Diploma, an Associates Degree in Health Care or equivalent knowledge and experience is preferred. Medical Terminology Course completion is required.

 

EXPERIENCE

 

Three years prior experience preferred. Knowledge of insurance and authorizations.

 

SPECIAL SKILLS

 

Excellent demonstrated communication skills, computer literate, working knowledge of EPIC electronic medical record is preferred. In accordance with the hospitals Service Excellence standards of operation, provide service excellence to patients, physicians and fellow Greenwich Hospital Employees.

 

PHYSICAL DEMAND

 

Light lifting and bending. Majority of the job is sedentary. Good vision and hearing with or without assistive devices is a requirement.

 


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