Position Goal

Obtain prior authorizations for all applicable scheduled services requiring prior approval to ensure a positive experience for both the patient and provider.

Position Responsibilities

• Responsible for obtaining precertification and prior authorization for all elective services requiring prior authorization.
• Utilize online portals as directed by payor to obtain prior authorization.
• Utilize online portals to ensure validity of prior authorization response.
• Contact payor via email and/or phone as needed as a method for verification.
• Responsible for obtaining and submitting all necessary information required to obtain precertification or prior authorization to include clinical dictation and test results.
• Organize stat and future surgical/procedure request within practice management system to ensure prioritization for timely submission of prior authorization requests.
• Provide accurate information to insurance companies based on test results, clinical dictation, etc. to support medical necessity of request as an effort to streamline approvals prior to procedure in the most efficient manner.
• Communicate to provider/staff of exceptions and denials to ensure patient satisfaction and awareness.
• Verify/re-verify insurance benefits and eligibility for each scheduled surgical procedure and/or test.
• Complete precertification and prior authorization process in a timely, efficient manner with respect to urgent requests.
• Update practice management system with corresponding validity of approval and/or denial.
• Clearly document reference numbers in instances where authorizations are not required.
• Update practice management system in associated prior authorization fields to ensure clean claim filing.
• Provide prior authorization back up to other staff members.
• Maintain productivity goal as outlined by Management.

Experience:

Required:

• None

Preferred:

• Experience in a medical setting.

Education: 

Required:

• High School Diploma or equivalent

Special Qualifications: 

• Must be able to work independently.
• Knowledge of CPT and ICD-10 terminology.
• Must be familiar with standard concepts, practices, and procedures of this particular field.
• Knowledge of the functionality/purpose of medical insurance.
• Knowledge of Medical Terminology.
• Proficient in computer navigation
• Must have a valid driver’s license and satisfactory Motor Vehicle Record (MVR).

The Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, Hughston Orthopaedics Trauma, Hughston Orthopaedics Southeast and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.