JOB TITLE: PRE-AUTHORIZATION REPRESENTATIVE
MAIN FUNCTION:
Works within a team environment pre-authorizing out patient exams for various hospital services. This position will require a degree of complexity and prior anatomy education. Reports directly to the Pre-Authorization Supervisor.
DUTIES AND RESPONSIBILITIES:
COMMUNICATION
• Promptly answers the telephone in a professional and courteous manner.
• Demonstrates the knowledge and ability to utilize various computer networks and telephone applications to procure pre-authorizations for patients.
• Demonstrates the ability to complete pre-authorizations in a timely manner.
• Demonstrates the ability to communicate courteously and effectively with internal and external customers.
• Demonstrates an understanding of both CPT , ICD9 and medical terminology.
• Demonstrates the ability to check appointment schedules daily to ensure that all admissions and procedures have been approved (pre-authorized) by the insurance carrier.
CLERICAL
• Demonstrates insurance knowledge.
• Demonstrates knowledge of ICD-9 coding / CPT / HCPCs to ensure Arnot Health to receive the maximum reimbursement that is allowable.
• Demonstrates knowledge of Medicare requirements for approved ICD-9 codes and to communicate to the provider when a code is not approved, and knowledge of Medicare waivers.
• Demonstrates the ability to accurately pre-authorize / pre-certify patients exams for all departments to ensure the smooth daily operation of the department.
• Has knowledge of the method of proper sequencing of exams (ie. prioritization).
• Communicates all questions to the appropriate department.
• Has ability to conference with other departments to bring about conflict resolution to pre-authorization problems.
• Demonstrates the ability to be cross-trained to other responsibilities of the department as required by the Supervisor/Director.
COMPUTER
• Demonstrates basic computer skills.
• Demonstrates the knowledge and ability to work within the Arnot Health's computer system.
• Maintains computer security.
WORKING RELATIONSHIP
• Has general knowledge of the Hospital's departments and how these departments interact with each other.
• Interacts with physician and physician's offices in a positive and courteous manner.
• Establishes and maintains collaborative working relationships with other health team members.
• May perform other duties as requested by supervisor/manager which contributes to the smooth operation of the department.
QUALITY
• Demonstrates reliability in the conscientious, complete and accurate manner in which work assignments are performed.
• Demonstrates Quality Improvement principles in daily work and participates in QI monitoring and reporting.
QUANTITY
• Demonstrates flexibility in work schedule to meet the needs of the department.
• Demonstrates the ability to perform multiple tasks as required by the position.
• Continuously utilizes time to maximize full potential, sets priorities and is uses good organizational skills.
SAFETY
• Functions within an awareness of risk management and safety issues, reports concerns appropriately.
• Maintains complete understanding of the Arnot Health's emergency codes.
PROFESSIONALISM
• Is accountable for own actions.
• Maintains professional behavior and appearance. Wears Arnot Health's ID Badge.
• Maintains and respects patients and patient confidentiality.
• Addresses internal and external customers in a pleasant and respectful manner, displaying courtesy at all times.
• Attends staff meetings.
OTHER
• Is responsible for attending all annual mandatory educational programs as required by position.
• Employee understands and demonstrates the importance of satisfying the needs of the customer/patient by interacting with him/her in a friendly and caring way, being attentive to the customer's needs, both psychologically and physically, and by taking the initiative to maintain communication with the customer in order to provide a secure and pleasant experience with Arnot Health.
• It is understood that this job description lists typical duties for the classification and is not to be considered inclusive of all duties that may be assigned.
EDUCATION
Mandatory: Clinical experience in various areas is needed/and or coding in various areas. ICD9/CPT coding certifications or prior billing experience.
High School diploma or equivalent experience required. Hospital experience preferred.
EXPERIE