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Employment Type:

Full time

Shift:

Description:

Position Purpose

Responsible for assisting patients and providers with the prior authorization of services including, but not limited to, prescriptions, office/laboratory/radiology/surgical procedures and durable medical equipment.

What You Will Do

+ Collects prior authorization requests initiated by physicians.

+ Initiates the prior authorization request to patient’s insurance carrier.

+ Maintains a line of communication between patient and insurance carrier.

+ Files authorizations from insurance carrier into patient chart.

+ Initiate’s letter of medical necessity from physicians.

+ Coordinates peer to peer review if required by insurance.

+ Notifies patient accounts staff/patients of insurance coverage lapses and self-pay patient status. May notify ordering providers if authorization is denied.

+ Assists with the processing of referrals and other duties as assigned in support of the billing or clinical departments.

+ Answers all incoming phone calls, facilitating communication among staff, ancillary departments, doctors and others by taking and transmitting messages and information to appropriate parties.

+ Receive incoming test results and direct appropriately for follow-up.

+ Processes patient referrals.

+ Maintains and updates information on referring physicians.

+ Sends letters and first appointment findings to referring physicians.

+ Keeps on-line patient management database updated.

Minimum Qualifications

+ High school graduate or equivalent.

+ Must be BLS certified within 3 months of hire.

+ Knowledge of medical terminology preferred with ability to read, write, and analyze required forms of documentation.

+ Knowledge of medical insurance and the concept of referrals/prior authorizations and their intended impact on health care delivery and reimbursement.

+ Working knowledge of CPT and ICD coding preferred.

+ Working knowledge of HIPAA laws and regulations.

+ Ability to work independently with minimal supervision.

+ Must display proper telephone etiquette.

+ Must be able to demonstrate basic computer skills in a Windows environment.

+ Must have good communication and diplomacy skills.

+ Must be comfortable operating in a collaborative, shared leadership environment.

+ Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission and vision, goals, and values of Trinity Health.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran