Education and Work Experience:

• High School Education/GED or equivalent: Preferred
• Associate’s/Technical Degree or equivalent combination of education/related experience: Preferred

Essential Functions:

• Performs daily reconciliation of scheduled procedures, documenting authorization numbers obtained by others, as well as obtaining any authorizations and retroactive authorizations as needed. Serves as the coordinator for scheduled and pre-authorized procedures.
• Reconciles, updates and obtains retroactive authorizations as needed. Performs insurance verification prior to office visit procedures. Interacts with providers and staff to provide guidance and advice with regard to billing, relative to necessary procedures.
• Serves as an authoritative source to reconcile and update the authorization numbers and generate a work list of authorizations needed. Communicates with insurance providers about the patient’s medical necessity, obtain authorization for needed authorizations and reconcile to the authorization database and/or hospital systems.
• Corrects inaccurate information, CPT and ICD9 codes that prohibit pre-authorization being secured and charges being entered into billing system.
• Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.