[Hiring] Preauthorization Representative @Arnot Health System

Role Description

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 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.
  • Adds 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.

Qualifications

• 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.

Experience

• Good organizational, communication, and customer relations skills.
• Telephone courtesy.
• Service oriented experience preferred.

Cardiopulmonary Resuscitation (CPR) Requirements

• No CPR required.

Physical Demands

• Light physical effort. Typical office job.

Exposure Category

• Category III. Tasks that involve no exposure to blood, body fluids, or tissues. Category I tasks are not a condition of employment.