Prior Authorization Representative

Experience these exceptional benefits when you join Med-Metrix!

• 8-Hour Shifts, Fixed Weekends Off
• Day 1 HMO with 2 of your dependents covered for FREE
• Group Life Insurance
• Medical Cash Allowance
• Rice Allowance
• Clothing Allowance
• Holiday Gift
• Bereavement Assistance
• Free Lunch Daily
• Paid Time Off
• Training and Staff Development
• Employee Engagement Activities
• Opportunities for Internal Mobility

The Prior Authorization Representative is responsible for obtaining and providing accurate and complete data input for precertification/preauthorization from insurance companies

Duties and Responsibilities

• Works effectively with insurance companies to obtain pre-certification/ authorization for services
• Places calls to various health plans to obtain appropriate precertification prior to the patient`s appointment
• Ability to understand/interpret documented clinical information and relay pertinent medical/clinical information to the insurance company
• Faxes to pre-certification request form to insurance company
• Maintains files and security of confidential information utilizing host system to scan and input data as per established procedures
• Verifies medical insurance information and documents in scheduling/registration modules
• Reviews claim denials and rejections
• Accurately enters and updates patient data, and other general data, into the computer system
• Patient intake; insurance verification, notification of copays/patient liability and confirmation of demographics
• Maintain account work progress, including but not limited to updating authorization logs, account referral in EMR, authorization paperwork and issue reports
• Demonstrates knowledge of varied managed care insurance and regulatory guidelines
• Meets and maintains daily productivity/quality standards established in departmental policies
• Uses the MPower workflow system, client host system and other tools available to them to collect payments and resolve accounts
• Adheres to the policies and procedures established for the client/team
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Communicate effectively with physician offices and patients.
• Place outbound call to patients with precertification notification.
• Work independently from assigned work queues
• Maintain confidentiality at all times
• Maintain a professional attitude
• Other duties as assigned by the management team

Qualifications

• Must have completed at least 1 year in College
• Medical terminology knowledge, required
• Minimum of 1 year of healthcare or physician's office related experience in obtaining and handling pre-authorizations
• Extensive knowledge of individual payor websites, including eviCore, Navinet and Novitasphere
• Knowledge of Medical Terminology, CPT Codes, Modifiers and Diagnosis Codes
• Experience in oncology is a strong preference.
• Proficiency with MS Office. Must have basic Excel skillset
• Experience with GE Centricity, EPIC PB, Allscripts, Cerner, preferred
• Must be amenable to work during US hours
• Must be amenable to work onsite