Job Description

Summary:

Responsible for patient prior authorization, patient referrals including scheduling of internal referral and outgoing patient referrals, documentation of status of prior authorizations and referrals, ability to navigate registration, referral entries, auth/cert entries, ability to update and confirm current patient insurance coverage and day to day monitoring of all prior authorizations and referrals work queues

• Communicates with patients and insurance companies regarding coverage and other related matters.
• Discusses benefits with patients, responds to patient/third party inquiries.
• Completes insurance verification /pre-certification according to payor requirements: Identifies outpatient procedures that require precertification /second opinion: obtains required information from physician; pre-certifies inpatient admissions.
• Conducts physician office/patient interviews and explains hospital procedure guidelines and policies
• Provides the patient with prep and other appointment instructions
• Follows guidelines for special requires /STAT/schedule modification procedures and coordinates communications with clinical areas to accommodate the patient requests
• Notifies patient of physician order, preauthorization and other financial clearance requirements.
• Other roles and responsibilities as assigned.

Requirements

Education/Experience:

• High school graduate or equivalent
• Prior medical experience and knowledge of insurance policies and procedures preferred
• Medical terminology knowledge preferred

Skill/Abilities:

• Excellent communication and interpersonal skills required to discuss financial matters with patients and/or their representative, and to work with all levels of professionals at JCH and in other organizations
• Ability to comprehend large amounts of complex information, and explain complex insurance benefits to patients and/or their representatives
• Ability to respond to quickly changing priorities and patient needs
• Demonstrated computer skills and relates experience preferred

Physical Requirements:

• Work is of light demand
• Motor coordination and finger dexterity required to operate computer equipment and other office machines

Benefits:

• Health Insurance
• Dental Insurance
• Vision Insurance
• Life Insurance
• Retirement
• Paid Time Off
• Tuition Reimbursement
• Health Savings Account
• Wellness Program
• Employee Assistance Program