Pre-Auth Specialist
  • Job Posting Expires: 7/1/2024
2W ago
$0 to $0
Full Time
No
Customer Services
0-2 Years
None
Primary Duties

The mission of Faith Regional Health Services is to serve Christ by providing all people with exemplary medical services in an environment of love and care.

Summary:

This position is responsible for obtaining and documenting insurance authorization prior to scheduled services as well as following up on non-scheduled services requiring pre-authorization. Coordinates communication of documented information to appropriate parties such as Central Scheduling, Registration, Ancillary Departments and Utilization Review. Works closely with central scheduling, financial counseling and various areas of patient accounting as necessary and assigned.

 

 

The listing of job duties contained in this job description is not all inclusive. Duties may be added or subtracted at any time due to the needs of the organization.

 

 

Responsibilities:

Essential Job Duties and Responsibilities:

  1. This position is responsible for the Pre-authorization process; works accounts that require follow up and/or as identified as lacking appropriate pre-authorizations. Will regularly review various dept. schedules and orders to ensure that all applicable pre-authorizations are requested and confirmed either by phoning insurance company and/or verification with physicians’ offices.

 

  1. Responsible for the running and execution of daily, weekly and monthly reports as assigned to include but not limited to: No Pre-Authorization, Procedure by Payer, Pre-registered Patient reports and any subsequent, accurate, timely completion of tasks associated with report findings and/or errors as assigned.

 

  1. This position is responsible for obtaining preauthorization for procedures from insurance companies directly when physician’s clinic is unable to do so and/or insurance company allows.

 

  1. This position ensures that all appropriate scanning and documentation of pre-certification, benefit and/or any/all required information gathered is clearly and concisely scanned and/or entered into the appropriate patient account and systems.

 

  1. This position must maintain a good working knowledge of insurance companies requiring pre-approval, keep data base current, utilizing software and internet sites for information/verification.

 

  1. Position requires a basic working knowledge of CPT and ICD-10 coding and medical terminology.

 

  1. This position will be responsible for cross training and backup to the Central Scheduling department for duties to include, but not limited to: EPIC EHR for scheduling of outpatient/inpatient appointments, obtaining and verifying physician orders, maintaining online filing system CS Orders Common, and any additional duties determined by the patient financial services manager.

 

 

Hours will be dependent on patient census and workload. Ability and willingness to work a flexible schedule, to include after-hours and weekends as necessary.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


Required Knowledge, Skills, and Abilities

Job Requirements:

The requirements listed below must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required.

EDUCATION :

GED or High School Diploma preferred.

Previous Experience Requirements:

EXPERIENCE:

Previous healthcare experience preferred.

 

 

 

1 year of previous experience in healthcare or customer service preferred.

Skills/Knowledge Requirements:

SKILLS (If Applicable):

 Language Skills – Ability to read, write, speak, and understand the English language required. 

KNOWLEDGE (If Applicable): 

 

Knowledge of CPT, ICD-10 Codes, and Medical Terminology preferred.

 

 

 

Faith Regional Health Services is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.


Compensation Details

Based on experience.


Benefits

FREE Dental Insurance for employee only with two FREE cleanings each year 

FREE Life Insurance 

FREE Urgent Care visits for qualifying symptoms including medical dependents 

Paid Time Off – 24 days per year accrued in PTO Bank for new-full time employees 

Health Insurance option of High Deductible or PPO Plan 

Health Savings Account with FRHS monthly contribution of $75

Vision Insurance 

Short Term Disability Insurance 

Long Term Disability Insurance 

Critical Illness Insurance 

Accident Insurance 

Supplemental Life Insurance 

Wellness Discounts for Health Insurance  

Smoking Cessation Program 

Met Law Legal Services Program  

YMCA and other local discounts