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+ JOB REQUIREMENTS

+ Education

+ Must be a high school graduate. Preferably 2 years of college prep or equivalent Vocational School training with an emphasis on accounting or business. Completion of medical terminology and coding classes in ICD-9-CM.

+ Experience

+ Pre-Authorization experience required. Two years in registration, scheduling, or business office required. Requires minimum of two years in ICD-9-CM coding experience. Previous healthcare billing and follow-up experience preferred. Able to work under deadline pressure. Ability to interact well with physicians, physician offices, business office personnel, etc. to obtain appropriate information needed to assign codes as well as communicating with the public and insurance carriers.

+ Physical

+ Normal hospital environment. Close eye work. Hearing within normal range. Operates, computer, telephone, copier, general office equipment. Continuous sitting. Occasional walking and bending within the work area. Lifting, carrying, pushing and pulling charts and office supplies up to 20 lbs.

+ JOB SUMMARY

+ + The Pre-Authorization Educator is responsible for collecting appropriate pre-authorization information and verifying coverage of patients admitted under group or private insurance plans. Must be able to converse with insurance company and review agency representatives and possess communication skills to provide needed information in a clear and concise manner. Is responsible for providing information from insurance companies and/or review agencies to appropriate medical center departments in an orderly and timely manner. Pre-Authorization Educator will work closely with Business Office, Medical Records, Scheduling, Registration, and Administration to assure insurance process, pre-authorization, and utilization review flows smoothly. Is responsible for educating the Admissions department and Pre Authorization Reviewers on insurance requirements, system processes, and new process implementation. Maintain good relations with clinics and clinical staff in a positive, professional manner. The employee is responsible for preparing and accurately coding the hospital charge sheets daily, as well as making sure all charge sheets are accounted for. The daily input of charges and verify accuracy of the entered data. Filing of electronic claims and working of the insurance reports every morning. Calling insurances to follow up on payment status or appeals due to denials or incorrect payments. Calling patients for insurance information and arrange payment plan if one is needed. This position requires timely response to inquiries from both the payer and the patient. This position has high contact with patients, employees, physicians, and other members of the community. Occasional stress related to workload and deadline time frames. Attendance is an essential function of this job.