Pre-Authorization Clerk

Uintah Basin Healthcare current open positions•Roosevelt, UT

21h

About The Position

The prior authorization clerk is responsible for ensuring that payers are prepared to reimburse Uintah Basin Healthcare for scheduled services in accordance with the payer-provider contract. The clerk contacts payers to request service authorization and may collect financial and/or demographic information from patients as needed. Identifies prearranged payment plans and follows instructions as outlined by the Patient Access Manager. Requests and collects self-pay balances per organizational guidelines.

Requirements

Prior authorization clerk responsibilities include ensuring payers are prepared to reimburse for scheduled services.
Contacting payers to request service authorization.
Collecting financial and/or demographic information from patients.
Identifying prearranged payment plans.
Following instructions from the Patient Access Manager.
Requesting and collecting self-pay balances.
Verifying patient's insurance and benefits information.
Obtaining prior authorizations from third-party payers.
Gathering demographic and insurance information from patients and updating EMR.
Working with other departments to gather clinical information for authorization.
Maintaining accurate records of authorizations in EMR.
Referring accounts to financial counseling if authorization is not obtained.
Supporting appeal efforts for authorization-related denials.
Complying with HIPAA regulations and organizational policies on patient privacy and confidentiality.
Maintaining a professional tone in communications.
Collecting, analyzing, and recording demographic, insurance, financial, and clinical data in a computer system.
Updating and editing information in the computer system.
Completing Medicare Secondary Payer Questionnaire and other payer-specific documents.
Posting payments within the billing system.
Securing or turning over collected monies.
Referring patients to Financial Counselors.
Ability to perform a variety of tasks and change assignments on short notice.
Adept at multi-tasking.
Proactively identifying and completing work.
Professional appearance and conduct.
Excellent attendance record.
Wearing appropriate clothing and ID badge.
Maintaining good rapport and cooperative working relationships.
Representing the organization positively.
Maintaining patient confidentiality.
Complying with ethical business practices.
Exceptional organization and time management skills.

Responsibilities

Verifies patient's insurance and benefits information.
Obtains prior authorizations from third-party payers in accordance with payer requirements.
Contacts patients to gather demographic and insurance information as needed, and updates patient information within the EMR as necessary.
Works with other departments to gather the clinical information required by the payer to authorize services.
Maintains accurate records of authorizations with EMR.
Refers accounts to financial counseling as needed if authorization is not obtained.
Works with business office staff to support appeal efforts for authorization-related denials.
Complies with HIPAA regulations, as well as the organization's policies and procedures regarding patient privacy and confidentiality.
Maintains a professional tone at all times when communicating with patients and payer representatives.
Performs all other duties as assigned by departmental leaders.
Accurately and thoroughly collects, analyzes, and records demographic, insurance, financial, and clinical data in a computer system.
Ensures the information source is appropriate.
Updates and edits information in the computer system, ensuring that all fields are populated correctly and appropriately.
Obtains information and completes Medicare Secondary Payer Questionnaire and other payer-specific documents as required.
Posts payments within the billing system.
Ensures that all monies collected are secured or turned over to appropriate associates.
Refers patients to Financial Counselors for in-depth financial counseling.
Ability to perform a variety of tasks, often changing assignments on short notice.
Must be adept at multi-tasking.
Readily identifies work that needs to be performed and completes it without needing to be told.
Ensures that appearance and personal conduct are professional at all times.
Excellent attendance record.
Wears appropriate clothing for job functions.
Wears ID badge.
Works at maintaining a good rapport and a cooperative working relationship with physicians, administration, and staff.
Represents the organization in a positive and professional manner in the community.
Maintains patient confidentiality at all times.
Complies with all organizational policies regarding ethical business practices.
Exceptional organization and time management skills.