What are the responsibilities and job description for the Prior Authorization Coordinator position at Orthopaedic Specialty Group?
Educational Requirements:
- High school diploma required.
- College education or trade school preferred.
- Certified Professional Coding certification helpful.
- Minimum 1-2 years of experience working in a physician group practice billing department.
- Minimum 1-2 years of experience working in a physician group practice billing department.
- Strong written and verbal communication skills.
- Knowledge of Anatomy & Physiology, and medical terminology.
- Current working knowledge of CPT, ICD10, and NCCI edits. Orthopaedics a plus.
- Experienced in working through Medicare, Commercial, and Medicaid clinical policies and reimbursement guidelines.
- Able to establish good relationships with insurance companies.
- Ability to perform multiple tasks simultaneously.
- Understands the sense of urgency in meeting the needs of our patients by quickly working through the authorizations.
- Comfortable using email and interacting with Internet applications.
- Knowledge of practice management and word processing software.
- Good analytical skills and an affinity for detail.
- Pleasant speaking voice and demeanor.
- Neat, professional appearance.
- Verifies that Medical necessity guidelines for each insurance carrier are met, based on Provider documentation, and CPT/ICD10 codes assigned for procedures.
- Reviews the Prior Authorization requests in a timely manner in Athena Practice.
- Documents all pertinent information in the Patient chart.
- Refers the patient to the OSG Financial Counselor to determine financial responsibility, prior to procedure.
- Compiles updated Library of insurance carrier guidelines.
- Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by the practice.
- Has detailed knowledge of EHR, PM system, and other software platforms, as it relates to job functions.
- Attends all regular OSG Department meetings.
- Performs all other tasks and project assigned by the Billing Manager and/or the Director of Revenue Cycle Management.
- This job has no supervisory responsibilities.