Clinic RN/Prior Authorizations

Overview

Obtaining authorizations for procedures and testing performed in office and hospital.

Responsibilities

This position is a full-time job working with prior authorizations and insurances. This role will consist of working with different insurances to obtain prior authorization through insurances to ensure the patient is properly covered. In this position, you will be responsible for working in the work queue for prior authorizations. The work queue will contain requests for various testing such as echocardiograms, nuclear stress testing, stress echocardiograms, ultrasounds, MRI’s, CTs/CTAs, etc. These authorizations must be obtained at least 30days prior to scheduled appointment. This role also includes checking the clinic echocardiogram schedule daily to ensure procedures are authorized. Obtaining authorizations can be done via phone, fax or internet. Training will be given that includes all access to insurance websites. This position will obtain prior authorizations for procedures performed in the hospital by physicians in our clinic such as heart catheterizations, pacemaker/defibrillator implants, ablations, tilt table tests, and more. This position is also responsible for any testing needed for patients with VA/Tricare insurance.  obtaining/requesting VA and tricare referrals. Scanning information into charts. communicating with providers/nurses if any issues arise with authorizations

Qualifications

Required RN, BLS, ACLS and prefer clinic experience and authorization knowledge.