PRIOR AUTHORIZATIONS

Artesia General Hospital • Artesia, NM

5d • $16 - $30 • Onsite

About The Position

Initiates and processes prior authorization requests from healthcare providers for medical procedures and surgical services. Verifies patient insurance coverage and benefits to determine requirements for prior authorization and collaborates with Artesia General providers, insurance companies, and patients to facilitate efficient authorization processes. Maintains accurate records of authorization requests, approvals, and denials. Communicates with providers and front-end office, insurance companies, and patients regarding authorization status, requirements, and appeals. Prepares and submits prior-authorization appeal requests as necessary. Communicates with patients their copay, out-of-pocket, co-insurance, and deductible amounts. Familiarity with insurance plans, authorization processes, and coverage policies. Accurate data entry and record keeping.

Requirements

• Proficiency in using electronic medical records systems
• Understanding medical terminology, procedures, and healthcare regulations
• Clear and effective communication and verbal skills
• Accurate data entry and record keeping
• Ability to resolve issues related to authorization request and denials.
• Ability to work independently and professionally.
• High School Diploma or GED
• Customer service experience preferred
• Good communication skills required
• Bi-lingual capabilities preferred
• Minimum of one year of prior authorization experience preferred
• Demonstrates the basic knowledge and skills (cognitive, technical and interpersonal) necessary to identify age-specific patient needs appropriate for all age groups.
• Treats all information and data within the scope of the position with appropriate confidentiality and security.
• Cooperates fully in all Risk Management, Quality Management, and Safety Activities and Investigations.

Nice To Haves

• Previous experience in healthcare medical billing and insurance authorization, preferred
• Ability to work overtime to meet deadlines or handle urgent authorization request.

Responsibilities

• Initiates and processes prior authorization requests from healthcare providers for medical procedures and surgical services.
• Verifies patient insurance coverage and benefits to determine requirements for prior authorization.
• Collaborates with Artesia General providers, insurance companies, and patients to facilitate efficient authorization processes.
• Maintains accurate records of authorization requests, approvals, and denials.
• Communicates with providers and front-end office, insurance companies, and patients regarding authorization status, requirements, and appeals.
• Prepares and submits prior-authorization appeal requests as necessary.
• Communicates with patients their copay, out-of-pocket, co-insurance, and deductible amounts.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED