Pre-Authorization Representative - Schuyler Hospital

Cayuga Health System•Montour Falls, NY

7d•$21 - $26•Onsite

About The Position

The Pre-Authorization Representative works within a team environment to pre-authorize outpatient exams for various hospital services. This position requires a degree of complexity and prior anatomy education. The role reports directly to the Pre-Authorization Supervisor.

Requirements

Clinical experience in various areas and/or coding in various areas.
ICD9/CPT coding certifications or prior billing experience.
High School diploma or equivalent experience required.
Good organizational, communication, and customer relations skills.
Telephone courtesy.
Basic computer skills.
Knowledge and ability to work within the Arnot Health's computer system.
Maintains computer security.

Nice To Haves

Prior anatomy education.
Hospital experience preferred.
Service oriented experience preferred.

Responsibilities

Promptly answers the telephone in a professional and courteous manner.
Utilizes various computer networks and telephone applications to procure pre-authorizations for patients.
Completes pre-authorizations in a timely manner.
Communicates courteously and effectively with internal and external customers.
Demonstrates an understanding of CPT, ICD9, and medical terminology.
Checks appointment schedules daily to ensure that all admissions and procedures have been approved (pre-authorized) by the insurance carrier.
Demonstrates insurance knowledge.
Demonstrates knowledge of ICD-9 coding / CPT / HCPCs to ensure Arnot Health receives the maximum reimbursement that is allowable.
Demonstrates knowledge of Medicare requirements for approved ICD-9 codes and communicates to the provider when a code is not approved, and knowledge of Medicare waivers.
Accurately pre-authorizes / pre-certifies patients exams for all departments to ensure the smooth daily operation of the department.
Has knowledge of the method of proper sequencing of exams (i.e. prioritization).
Communicates all questions to the appropriate department.
Conferences with other departments to bring about conflict resolution to pre-authorization problems.
Is cross-trained to other responsibilities of the department as required by the Supervisor/Director.
Demonstrates basic computer skills.
Works within the Arnot Health's computer system.
Maintains computer security.
Has general knowledge of the Hospital's departments and how these departments interact with each other.
Interacts with physician and physician's offices in a positive and courteous manner.
Establishes and maintains collaborative working relationships with other health team members.
May perform other duties as requested by supervisor/manager which contributes to the smooth operation of the department.
Demonstrates reliability in the conscientious, complete and accurate manner in which work assignments are performed.
Demonstrates Quality Improvement principles in daily work and participates in QI monitoring and reporting.
Demonstrates flexibility in work schedule to meet the needs of the department.
Performs multiple tasks as required by the position.
Continuously utilizes time to maximize full potential, sets priorities and uses good organizational skills.
Functions within an awareness of risk management and safety issues, reports concerns appropriately.
Maintains complete understanding of the Arnot Health's emergency codes.
Is accountable for own actions.
Maintains professional behavior and appearance. Wears Arnot Health's ID Badge.
Maintains and respects patients and patient confidentiality.
Addresses internal and external customers in a pleasant and respectful manner, displaying courtesy at all times.
Attends staff meetings.
Is responsible for attending all annual mandatory educational programs as required by position.
Understands and demonstrates the importance of satisfying the needs of the customer/patient by interacting with him/her in a friendly and caring way, being attentive to the customer's needs, both psychologically and physically, and by taking the initiative to maintain communication with the customer in order to provide a secure and pleasant experience with Arnot Health.