Patient Access Pre Reg And Prior Auth Rep

Brattleboro Memorial Hospital•Brattleboro, VT

1d•$18 - $26•Onsite

About The Position

The Prior Authorization Representative is responsible for all aspects of the prior authorization process for ambulatory, outpatient, inpatient, and infusion services at BMH. Responsibilities include collecting all the necessary documentation for complete, timely, and accurate identification and submission of prior authorizations. Perform functions related to denials, appeals, and retro-authorizations. Interact with various internal departments, insurance companies, and patients, in a friendly helpful manner. Document account activity and update patient and claim information to ensure all functionalities are utilized for the most efficient processing of claims. Identify prior authorization trends and/or issues that may result in delayed claims processing. Provide coverage periodically with outpatient registrations and pre-registrations, as needed (Patient Services Representative). Treat patients with utmost courtesy and respect in accordance with the Patient Bill of Rights. Work shifts as directed, demonstrating flexibility with vacation, holiday and sick call outs to support the operations of the department. Maintain knowledge of, and complies with, all relevant laws, regulations and policies, procedures and standards. Actively participate in creating and implementing improvements to achieve patient satisfaction. This position reports directly to the Supervisor of Prior Authorizations. The Prior Authorization Department is primarily responsible for insurance verification and obtaining prior authorization for future and scheduled appointments/referrals. This department reviews denials, appeals, and retro-authorizations related to prior authorization. As a sub-department of Patient Financial Services, Prior Authorization Department will assist with pre-registration and in person registration as needed.

Requirements

High School diploma required
Prior Customer Services Experience required
Experience with standard Microsoft Office applications, i.e Outlook, Word, Excel and other data entry processing applications
Strong oral and written communication skills with all levels of the organization and with external contacts
OSHA Category I - Tasks that involve exposure to blood, body fluids, or tissues require use of techniques of Universal Precautions as evidenced with blood borne pathogens standards.
Close Vision (clear vision at 20 inches or less)
Color Vision (ability to identify and distinguish colors)
Ability to Adjust Focus (ability to adjust eye to bring an object into sharp focus)
Ability to hear calls
Ability to hear instructions from physician/department staff/others

Nice To Haves

Associate degree preferred
Preferred in a medical office/hospital setting.
Prior Experience with Prior Authorization, Utilization Review, Medical Billing/Coding, or Patient Registration preferred
Knowledge of Medical Terminology and Pharmaceuticals preferred.
Experience with EMR/EHR systems preferred.
Strong Analytical and Problem-Solving Skills
Demonstration of strong organizational and time management skills

Responsibilities

Responsible for all aspects of the prior authorization process for ambulatory, outpatient, inpatient, and infusion services at BMH.
Collecting all the necessary documentation for complete, timely, and accurate identification and submission of prior authorizations.
Perform functions related to denials, appeals, and retro-authorizations.
Interact with various internal departments, insurance companies, and patients, in a friendly helpful manner.
Document account activity and update patient and claim information to ensure all functionalities are utilized for the most efficient processing of claims.
Identify prior authorization trends and/or issues that may result in delayed claims processing.
Provide coverage periodically with outpatient registrations and pre-registrations, as needed (Patient Services Representative).
Treat patients with utmost courtesy and respect in accordance with the Patient Bill of Rights.
Work shifts as directed, demonstrating flexibility with vacation, holiday and sick call outs to support the operations of the department.
Maintain knowledge of, and complies with, all relevant laws, regulations and policies, procedures and standards.
Actively participate in creating and implementing improvements to achieve patient satisfaction.
Insurance verification and obtaining prior authorization for future and scheduled appointments/referrals.
Reviews denials, appeals, and retro-authorizations related to prior authorization.
Assist with pre-registration and in person registration as needed.