Prior Authorization

Job Summary:

Responsible for obtaining Prior Authorization primarily for Viscosupplementation Injections. Liaison between Patients, Clinical staff, Insurance carriers, and Prior Authorization Team to facilitate authorizations for patient procedures.

Schedule Requirements:

• Full-time schedule consistent with the needs of the practice.
• No on-call requirements.
• No weekend requirements

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.

Qualifications & Skills:

• Minimum 1-2 years of experience working in a physician group practice billing or prior auth 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.

Responsibilities (including but not limited to):

• 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 the Summit Dashboard and Athena.
• Documents all pertinent information in the Summit Dashboard.
• Refers the patient to the 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 Department meetings.
• Performs all other tasks and project assigned by the Billing Manager and/or the Director of Revenue Cycle Management Administrative Services.
• This job has no supervisory responsibilities.

Typical Physical Demands:

Position requires prolonged sitting, some bending, stooping, and stretching. Good eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment is also required. Employee must have normal range of hearing and eyesight to record, prepare, and communicate appropriate reports. Working conditions are similar to those of a typical office environment.

OrthoConnecticut, delivering exceptional care and real results has always been our mission, though we did things a little differently when we opened our doors in 1954. Today, we provide orthopedic care in a new state-of-the-art Musculoskeletal Center of Excellence, in which we provide the full spectrum of high-quality services under one roof. Now we can diagnose and treat the complete range of musculoskeletal issues for all ages in one easily accessible location with minimal wait time and a more efficient patient experience. One thing that hasn't changed since in 1954: our commitment to you

OrthoConnecticut is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

The above statement reflects the general duties considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all the work requirements that may be inherent in the job.