Will ensure all authorizations are entered and updated according to CMS and Peoples Health policies within established production and accuracy benchmarks.
The Authorization Examiner enters and updates authorizations in the Amisys and CCMS systems and Macess Doc-Flo systems and makes logical benefit decisions to adjudicate Medicare and commercial claims utilizing a variety of other programs and screens. Some pended claims require assistance from other departments to process, such as: Medical Management, Provider Affiliations, Member Services and IT. Will also research and respond to service form requests. The Authorization Examiner must meet established production and accuracy benchmarks.
- Researches and responds to service forms in a clear and concise manner.
- Processes authorization related pended claims through the Macess Doc-Flo and Amisys and CCMS systems according to CMS and Peoples Health policies and procedures
- Ensures individual production and accuracy benchmarks are met
- Assists with maintaining consistent departmental inventory levels
- Researches and responds to service forms in a clear and concise manner
- Operates as a team player to ensure open communication and establishes trust that supports a team environment in the unit
College degree highly preferred. Excellent keystroke competency as well as 10 key skills needed in addition to proficient PC skills including experience with MS Office Suite in order to process claims. Minimum of 1-2 years claims processing or billing experience preferred as well as knowledge of medical terminology and/or CPT, ICD-9 coding knowledge.
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