MEDICAL RECEPTIONIST WITH KNOWLEDGE OF PRIOR AUTHORIZATION

• Patient Check-in and Registration: Front staff greet patients, collect necessary personal information, verify insurance details, and update medical records.
• Appointment Scheduling: They schedule patient appointments, confirm existing appointments, and handle rescheduling requests.
• Patient Communication: Medical front staff often handle phone calls, answer questions about services, relay test results, and follow up with patients as needed.
• Insurance Verification and Billing: They assist with verifying insurance coverage, process billing inquiries, and ensure that payments are collected or handled appropriately.
• Medical Record Management: Front office staff may assist in managing electronic medical records (EMRs), ensuring patient data is up-to-date and accurate.
• Coordination with Medical Staff: They communicate between patients and healthcare providers, ensuring that doctors, nurses, and other medical personnel have the necessary information.
• Managing Waiting Area: They keep the waiting area organized, ensuring patients are called promptly and kept informed about delays.
• Compliance and Privacy: They ensure that patient privacy is maintained in accordance with regulations like HIPAA (Health Insurance Portability and Accountability Act).

OBTAINING PRIOR AUTHORIZATION

1. Understanding the Insurance Requirements

• The front staff needs to be knowledgeable about the insurance plans that the clinic or healthcare facility accepts.
• They must understand the procedures, medications, and treatments that typically require prior authorization.
• They should stay updated on any changes in insurance policies or requirements for specific procedures.

2. Submitting Prior Authorization Requests

• The front office staff, often working closely with the medical billing department or the provider's office, is responsible for initiating the prior authorization process by submitting the required documentation to the insurance company.
• This can include filling out forms, providing medical records, diagnostic reports, and letters of medical necessity from the healthcare provider.

3. Coordination with Healthcare Providers

• Medical front staff communicates with doctors or other healthcare professionals to gather the necessary documentation or information for the authorization request.
• They may need to ask for specific clinical notes, test results, or justification for why the service or treatment is needed.

4. Following Up on Authorization Status

• Once the request is submitted, front staff must follow up with the insurance company to track the status of the prior authorization.
• They need to check for approvals, denials, or requests for additional information and ensure that the process is moving forward.

5. Handling Denials and Appeals

• If the prior authorization request is denied, the front staff may need to assist in appealing the decision. This could involve resubmitting the necessary documentation or providing additional supporting information.
• They may need to coordinate with the billing department or medical professionals to appeal the decision effectively.

6. Communicating with Patients

• The front office staff may need to explain the prior authorization process to patients, especially when there are delays or denials.
• They should also inform patients about what they need to do, like gathering additional information or understanding what their financial responsibility may be if prior authorization is denied.

7. Documenting Everything

• All interactions related to prior authorization should be thoroughly documented, including requests, communications, and follow-up actions.
• Proper documentation helps ensure that the process is smooth, and in case of any future disputes or audits, accurate records can be referred to.

Job Type: Full-time

Pay: $16.00 - $17.00 per hour

Benefits:

• 401(k)
• Health insurance

Ability to Commute:

• Taylor, MI 48180 (Required)

Ability to Relocate:

• Taylor, MI 48180: Relocate before starting work (Required)

Work Location: In person

Salary : $16 - $17