What are the responsibilities and job description for the Clinic Prior Authorization Specialist GNMSS position at Box Butte General Hospital?
Title : Clinic Prior Authorization Specialist
Reporting Relationship : Clinic Manager
General Summary of Responsibilities : Verify insurance coverage, pre-certification, and / or pre-authorization requirements for Inpatient, Outpatient Observation, and Surgery patients. Coordinate activities with the Utilization Review, Surgery, and other departments to ensure pre-certification requirements are met. Conduct all communications in a manner that results in positive patient relations. May provide clerical support services and handle mail operations.
Essential Job Functions :
- Coordinates activities with hospital departments to assist in meeting pre-certification or pre-authorization requirements for outpatient and clinical patients.
- Communicates with the clinical departments to access patient information and assist in meeting insurance pre-certification requirements for patients for outpatient imaging and medication for prior authorization.
- Contact a patient’s insurance company to verify coverage & benefits for outpatient services and medication prior authorization.
- Contact the patient or his / her representative by phone to gather demographic and insurance information prior to outpatient services.
- Contact insurance companies via internet and / or phone to verify insurance eligibility and document coverage and benefits.
- Enters patient demographic and insurance information in the EHR system efficiently and accurately.
- Document information relating to insurance eligibility, pre-certification and / or pre-authorization information or confirmation numbers.
- Follows up on insurance non-payment claims relating to pre-cert or pre-authorization requirements.
- Handles phone, mail and personal inquiries from and regarding patient accounts.
- Assists each person promptly, efficiently and courteously.
- Follow through on all issues identified as requiring action as a result of inquiry.
- Document all phone and personal inquiries in the EHR system.
- Performs duties with a minimum of supervision, exhibits innovation and good judgment.
Other Job Functions :
Performs other related duties as assigned or requested
Job Qualifications :
Age Requirement : Must be 19 yrs or older
Required : High School graduate or equivalent
Education :
Required : High School graduate or equivalent
Preferred : One or more years of college coursework in business administration, insurance operations and / or medical coding.
Conditional : Experience :
Required : Computer Skills / Keyboarding
Preferred : Previous medical billing experience.
Conditional : Experience :
Required :
Preferred : CCAT, Certified Clinic Account Technician or Certified Patient Account Technician (CPAT)
Personal Skills :
Dedication to professional performance across BBGH-owned clinics and hospital-wide.
Ability to respond quickly and efficiently to workload demands; ability to prioritize and complete tasks within appropriate time frames.
Good interpersonal and communication skills to effectively work with all parties the position contacts. Ability to communicate pleasantly and tactfully with employees, patients, family members, visitors, and the general public.
Positive attitude and willingness to represent the department positively both internally and externally.
Perform duties with minimal supervision, exhibiting innovation and good judgment.
Excellent computer skills, including the use of Outlook, Internet Explorer, Word, and Excel.
Ability to follow complex regulations and instructions.
Ability to learn and cross-train in various positions.
Support and commit to hospital-wide initiatives supporting the BBGH Values, Vision, and Mission Statements.
Other Information : Box Butte General Hospital is an Equal Opportunity Employer. Post-offer / pre-employment background check and drug screen are required.
PI258952442
