Pre-Authorization Specialist-Cardiology Clinic

Work Status Details :

Full Time | 80.00 Hours Every Two Weeks

Exempt from Overtime :

Non-Exempt

Shift Details : M-F 8a-4 : 30p

Department : Cardiology FRPS |

Reports To :

Director-Cardiac Services

The mission of Faith Regional Health Services is to serve Christ by providing all people with exemplary medical services in an environment of love and care. As a provider-led multispecialty healthcare team, Faith Regional Physician Services is committed to delivering high-quality, comprehensive services to the people of Northeast Nebraska.

Summary :

Perform clerical and pre-authorization functions for a physician in a clinic setting. This includes primary responsibility of the pre-authorization of procedures and tests performed by the physician. Must be able to communicate effectively with patients and insurance companies to ensure payment for the services performed.

The listing of job duties contained in this job description is not all inclusive. Duties may be added or subtracted at any time due to the needs of the organization.

Responsibilities :

Essential Job Duties and Responsibilities :

Demonstrates ability to appropriately modify approach and procedures to meet needs of age / diversity of population served for the following age groups :

☐ Neonate (birth - 28 days)

☐ Infant (29 days - less than 1 year)

☐ Pediatric / Child (1 year - 12 years)

☐ Adolescent (12 years - 18 years)

☒ Adult (18 years - 65 years)

☒ Geriatric (over 65 years)

Incorporates cultural considerations in the provisions of care.

Knowledge of growth and developmental stages.

Considers life changes / effects on health beliefs and behaviors.

Provides necessary safety measures.

Provides information and involves family / caregiver in decision making.

2. Work effectively with insurance companies to get pre-authorization completed in a timely manner.

3. Detailed understanding of ICD-10 and CPT coding is important.

4. Communicates effectively and routinely with clinical staff on the status of the pre-authorization; and documents the pre-authorization approval or denial in the appropriate areas within the EMR. Follows up with staff and clinicians accordingly.

5. Prioritizes workload and develops system to track prior authorizations needing additional follow-up.

6. Takes personal responsibility for work. Fosters teamwork, taking the initiative to teach pre-authorization to team members and clinic staff about pre-authorization processes and insurance requirements.

7. Communicates effectively with other staff and outside facilities.

8. Completes benefits investigations as needed.

9. Navigate through the EMR to find the required patient medical information.

10. Maintains confidentiality of patient records.

11. Responsible for faxing, phone calls and clerical tasks.

Hours will be dependent on patient census and workload. Ability and willingness to work a flexible schedule, to include after-hours and weekends as necessary.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Other information : Job Requirements :

The requirements listed below must be representative of the knowledge, skills, minimum education, training, licensure, experience, and / or ability required.

EDUCATION :

Associate Degree preferred.

Previous Experience Requirements :

EXPERIENCE :

Previous clinical experience preferred.

Previous healthcare experience preferred.

Skills / Knowledge Requirements :

SKILLS :

Language Skills - Ability to read, write, speak, and understand the English language required.

Computer Skills - Ability to use computers and related technology efficiently required.

Customer Service required.

Time Management - Ability to manage time and tasks efficiently required.

Interpersonal Skills - Ability to socially interact and communicate required.

KNOWLEDGE :

Electronic Medical Record Software required.

Medical Terminology preferred.

Patient rights, safety rights, safety practices, infection control practices, and risk management preferred.

Faith Regional Health Services is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.