PRIOR AUTHORIZATIONS

ESSENTIAL FUNCTIONS: Initiates and process prior authorization requests from healthcare providers for medical procedures and surgical services. Verify patient insurance coverage and benefits to determine requirements for prior authorization and collaborate with Artesia General providers, insurance companies, and patients to facilitate efficient authorization processes. Maintain accurate records of authorization requests, approvals and denials Communicate with providers and front-end office, insurance companies, and patients regarding authorization status, requirements and appeals. Prepare and submit prior-authorization appeal requests as necessary Communicates with patients their copay, out-of-pocket, co-insurance and deductible amounts. Familiarity with insurance plans, authorization processes and coverage policies Accurate data entry and record keeping. KNOWLEDGE/SKILL/ABILITIES: Proficiency in using electronic medical records systems Understanding medical terminology, procedures, and healthcare regulations Clear and effective communication and verbal skills Accurate data entry and record keeping Ability to resolve issues related to authorization request and denials. Ability to work independently and professionally. EDUCATION AND EXPERIENCE High School Diploma and or GED Previous experience in healthcare medical billing and insurance authorization, preferred Ability to work overtime to meet deadlines or handle urgent authorization request. AGE-RELATED COMPETENCIES: Demonstrates the basic knowledge and skills (cognitive, technical and interpersonal) necessary to identify age-specific patient needs appropriate for all age groups. Information Management: Treats all information and data within the scope of the position with appropriate confidentiality and security. Risk Management/Quality Management/Safety: Cooperates fully in all Risk Management, Quality Management, and Safety Activities and Investigations. ENVIROMENTAL CONDITIONS: Work environment consists of daily patient contact, which may include exposure to blood, or other body fluids.

MINIMUM POSITION QUALIFICATIONS: Education – High School Diploma Work Experience – Customer service experience preferred, good communication skills required, bi-lingual capabilities preferred. Minimum of one year of prior authorization experience preferred. Training – N/A License/Certification – N/A