FQHC Pre-Authorization Specialist
Atlanticare
Job Description
Pre-authorization Specialist is responsible for the patient registration process, infusion center admissions, co-pay cash collection, and financial arrangement issues. This position verifies third party payer accounts, pre-authorization and/or pre-certification requirements. In addition, this position will be responsible for interfacing with all private payers or their designees to obtain authorization for treatments and or imaging/lab studies and will facilitate physician to physician peer reviews of questionable cases. This position assures assignment of appropriate codes and Diagnosis Related Group (DRG) codes, collects quality statistical information, and assures timely follow up and processing of all accounts. Finally, this position will perform charge data reconciliation of all infusion accounts. This position also collects data for statistical and/or financial analysis. This position will require ongoing communication and collaboration with the infusion team members and provides quality customer service. This position supports organizational goals by providing quality customer service, participating in performance improvement efforts and demonstrating a commitment to teamwork and cooperation.
Qualifications
Education: High school diploma or equivalent required. Ability to read, write, and speak English is required.
Experience: 1-3 years medical office experience required, healthcare preferably in a medical setting. Knowledge of medical or dental terminology preferred. Knowledge of general computer and data entry functions required.
Performance Expectations Demonstrates the competencies as established on the Assessment and Evaluation Tool for this position.
Work Environment Potential for exposure to the hazards and risk of the hospital environment, including exposure to infectious disease, hazardous substances, and potential injury. This position requires reaching, stooping, kneeling, and crouching approximately 25% of the workday. This position also requires frequently lifting, approximately 25-30 pounds, and occasional lifting of 50-100 pounds with assistance. The essential functions for this position are listed on the Assessment and Evaluation Tool.
Reporting Relationship This position reports to the Infusion Medical Director or designee.
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