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