Responsible for maintaining incoming and out going authorizations and referrals.
Requires sitting for long periods of time. Working in office environment. Some bending and stretching required. Working under stress and use of telephone required. Manual dexterity required for use of calculator and computer keyboard. Work is performed in an office environment. Extensive telephone contact with insurance companies, medical facilities, patients and internal staff. Reports to Patient/Manage Care Representative Supervisor.
Duties: 1. Maintain & process incoming and out going authorizations.
2. Research "Non-authorized" denials and obtain retroactive authorizations when applicable.
3. Provide inter-departmental authorizations and internal referrals.
4. Maintain out going referrals for primary care and specialty physicians.
5. Provide support to satellite offices in securing retroactive authorizations when applicable.
6. Obtain prior approval authorizations for specialists performing test or procedures. **Nurses or scheduling personnel are responsible for notifying the Manage Care Representative when procedures or outside testing is needed.
7. Obtain in-patient authorization or precertifications for hospital admissions.
8. Notify appropriate personnel of any changes required by insurance companies.
9. Provide coverage for manage care co-workers during vacation, sickness, leave of absence, etc.
This job description in no way states or implies that these are the only duties to be performed by this employee. He or she will be required to follow any other instructions and to perform any other duties requested by his or her supervisor.
Qualifications: One year of insurance processing experience required. One year of Managed Care processing preferred or 2 years of medical office reception experience dealing with insurance and managed care issues. Prefer someone who is detail oriented, self-motivated and has the ability to work independently. Knowledge of insurance rules and regulations preferred. Medical experience preferred.