Prior Authorization Clerk - Full Time

Three Crosses Regional Hospital•Las Cruces, NM

About The Position

Three Crosses Regional Hospital is seeking a Prior Authorization Clerk committed to clinical excellence and building a patient-centered culture. The role ensures patient registration information is thorough and accurate, follows up on accounts requiring further evaluation, and works effectively in a team environment. The incumbent is expected to uphold the hospital’s ethical and moral standards and support its mission, vision, and values. The position requires knowledge of health care systems and the ability to interact with and support a diverse workforce.

Requirements

High school diploma or equivalent.
Knowledge of health care systems.
Demonstrated ability to interact with, relate to, work with, and support the activities of a diverse workforce.
Ability to work well in a team environment.

Nice To Haves

One year of customer service experience in a hospital setting.

Responsibilities

Maintain patient demographic information and data collection systems.
Verify insurance eligibility for upcoming appointments using online carrier websites or by contacting insurance carriers directly.
Review patient deductibles and copays and enter them in the Electronic Health Record and spreadsheets provided to the front-end department.
Coordinate with schedulers regarding discrepancies.
Help front-end staff understand carrier websites and verify eligibility.
Enter insurance correspondence as needed.
Participate in developing organizational procedures and updating forms and manuals.
Answer questions from patients, clerical staff, and insurance companies.
Work with schedulers and financial counselors to ensure clean billing.
Perform miscellaneous job-related duties as assigned.
Participate in educational activities and attend monthly staff meetings.
Maintain strict confidentiality and adhere to HIPAA guidelines and regulations.
Assist in developing and communicating SOPs for key areas to improve accuracy and understanding of processes.
Attend staff meetings as needed.
Perform other duties as assigned by the department manager or director.