What are the responsibilities and job description for the Prior Authorization Coord position at Rhode Island Hospital?
Summary:
Under supervision of the Business Manager is responsible for the integrity of the prior authorization processes for Adult Ambulatory Services. Coordinates and arranges for assigned internally generated orders to ensure patients have received financial clearance from insurance companies and troubleshoot as needed.
Responsibilities:
Confirms patient eligibility with insurance carriers/third party payors and obtains pre-authorization requirements in accordance with established medical policies.
Coordinates and ensures appropriate insurance authorizations are obtained and/or received in a timely manner.
Reviews recognizes and understands clinical documentation from patient records pertinent to obtaining prior authorization as necessary.
Analyzes orders authorizations and records for discrepancies that may affect insurance coverage and/or denial of claims.
Notifies and coordinates with ordering physicians and providers when peer-to-peer discussions are required to obtain prior authorization of services being denied by patients insurance.
When necessary contacts agencies outside the hospital to obtain pertinent patient information and to coordinate clinic/treatment
programs.
Collaborates with various Brown University Health personnel to resolve billing issues authorization denials and insurance denials/write-offs.
Provides mature quality customer service to patients their families and/or their representatives.
Ensures all patients are financially cleared by insurance/ third party payor prior to their scheduled appointments.
As assigned ensures staff is made aware of changes in hospital or third-party procedures; ensures appropriate training and adherence to approved policies and processes directly or through supervisory staff.
Regularly participates in business team meetings with staff and management to make recommendations where there are perceived problems.
Performs other duties as assigned.
Other information:
BASIC KNOWLEDGE:
High school diploma or equivalent required. Knowledge of business systems office procedures computer skills medical terminology and health insurance processes/terminology including but not limited to CPT and ICD-10 coding.
Strong organizational skills critical thinking and focus to detail required to manage high volume of radiologic orders requiring prior authorization and/or financial clearance.
Analytical skills to evaluate effectiveness of work flow with the ability to make recommendations develop and adapt to changes as necessary.
Interpersonal skills necessary to provide effective communication with patients and other healthcare professionals within and outside of Brown University Health.
EXPERIENCE:
Two years of previous experience in health care environment with emphasis in health insurance billing and reimbursement healthcare operations database management and patient/ provider interaction.
WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:
Normal office environment; may experience some visual fatigue as result of extended periods of work on the computer.
INDEPENDENT ACTION:
Performs independently within the departments policies and practices. Refers specific complex problems to the supervisor when clarification of the departmental policies and procedures are required.
SUPERVISORY RESPONSIBILITY:
None.
Brown University Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status. Brown University Health is a VEVRAA Federal Contractor.
Location: Rhode Island Hospital USA: RI: Providence
Work Type: Part Time
Shift: Shift 1
Union: Non-Union
Test
Under supervision of the Business Manager is responsible for the integrity of the prior authorization processes for Adult Ambulatory Services. Coordinates and arranges for assigned internally generated orders to ensure patients have received financial clearance from insurance companies and troubleshoot as needed.
Responsibilities:
Confirms patient eligibility with insurance carriers/third party payors and obtains pre-authorization requirements in accordance with established medical policies.
Coordinates and ensures appropriate insurance authorizations are obtained and/or received in a timely manner.
Reviews recognizes and understands clinical documentation from patient records pertinent to obtaining prior authorization as necessary.
Analyzes orders authorizations and records for discrepancies that may affect insurance coverage and/or denial of claims.
Notifies and coordinates with ordering physicians and providers when peer-to-peer discussions are required to obtain prior authorization of services being denied by patients insurance.
When necessary contacts agencies outside the hospital to obtain pertinent patient information and to coordinate clinic/treatment
programs.
Collaborates with various Brown University Health personnel to resolve billing issues authorization denials and insurance denials/write-offs.
Provides mature quality customer service to patients their families and/or their representatives.
Ensures all patients are financially cleared by insurance/ third party payor prior to their scheduled appointments.
As assigned ensures staff is made aware of changes in hospital or third-party procedures; ensures appropriate training and adherence to approved policies and processes directly or through supervisory staff.
Regularly participates in business team meetings with staff and management to make recommendations where there are perceived problems.
Performs other duties as assigned.
Other information:
BASIC KNOWLEDGE:
High school diploma or equivalent required. Knowledge of business systems office procedures computer skills medical terminology and health insurance processes/terminology including but not limited to CPT and ICD-10 coding.
Strong organizational skills critical thinking and focus to detail required to manage high volume of radiologic orders requiring prior authorization and/or financial clearance.
Analytical skills to evaluate effectiveness of work flow with the ability to make recommendations develop and adapt to changes as necessary.
Interpersonal skills necessary to provide effective communication with patients and other healthcare professionals within and outside of Brown University Health.
EXPERIENCE:
Two years of previous experience in health care environment with emphasis in health insurance billing and reimbursement healthcare operations database management and patient/ provider interaction.
WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:
Normal office environment; may experience some visual fatigue as result of extended periods of work on the computer.
INDEPENDENT ACTION:
Performs independently within the departments policies and practices. Refers specific complex problems to the supervisor when clarification of the departmental policies and procedures are required.
SUPERVISORY RESPONSIBILITY:
None.
Brown University Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status. Brown University Health is a VEVRAA Federal Contractor.
Location: Rhode Island Hospital USA: RI: Providence
Work Type: Part Time
Shift: Shift 1
Union: Non-Union
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