Nature of Duties:
In this role, you complete authorizations for any medical services ordered by CIS providers. In addition to reviewing the medical history of potential patients, you verify the information provided and verify their insurance coverage. You also monitor the schedule for our add-on patients, ensuring there are no conflicts and that we have the prior authorization we need to move forward with their appointment or procedure.

Qualifications:

• Medical terminology preferred (Cardiology)
• Experience/knowledge of pre-certification and/or hospital admit procedures preferred
• Excellent verbal and written communication skills
• Strong computer skills
• Excellent customer service skills
• Ability to organize and interpret data
• Must be a team player willing to accept organizational goals, function with minimal supervision.
• Independent discretion/decision making

Specific Duties:

1. Perform pre-certifications when required by various insurance carriers on diagnostic testing and procedures, such as CT, Nuclear perfusions, PET, ultrasounds, and Cath procedures, and document appropriately. Communicate with insurance companies regarding patient’s treatment and services provided by CIS. Communicate with the staff, diagnostic departments, Cath Lab, and/or patient regarding the status of the pre-certifications and help minimize patient wait times as much as possible.

2. Prioritize incoming prior authorization requests according to urgency.

3. Request, track and obtain prior authorization from insurance carriers within the time allotted for medical and services using insurance websites/portals, fax, or verbal communication.

4. Review patient chart documentation to ensure accuracy of prior authorization submissions.

5. Follow-up on prior authorizations submitted and initiate appeals for denied requests.

6. Use ICD-10 and CPT codes accurately and adequately in the submission of prior authorizations.

7. Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures, including HIPAA regulations.

8. Document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.

9. Ability to evaluate options and make efficient decisions.

10. Organizational skills sufficient to maintain consistently accurate records.

11. Ability to learn and become proficient in multiple computer programs and software.

12. Understands insurance requirements for prior authorizations. Serves as a primary resource to all clinic staff regarding prior authorization requirements for all services provided.

13. Works daily queues according to department directives to ensure all payer-specific authorization requirements are met, and authorizations successfully obtained while consistently meeting department productivity standards.

14. Performs other related duties as assigned and serves in any additional capacity deemed necessary for successful completion of the mission and goals of CIS and in concordance with its patient philosophy.

STANDARDS OF PERFORMANCE: