Receptionist/Prior Auth Clerk- Urology Clinic

Description Job Summary: Provides a broad range of clerical functions for physicians and patients.ESSENTIAL FUNCTIONS:

• Greet patients, visitors and co-workers in a prompt, courteous, and helpful manner.
• Maintain appointment scheduler and follow office-scheduling policy.
• Register patients in a complete and accurate manner to conform to all regulatory requirements.
• Collect monies at time of service.
• Reviews provider medical records to gather information for approvals from the various insurance plans.
• Handle pre-certification and referrals.
• Handles all prior authorizations on test as well as medications.
• Follow up on prior authorizations; ensure that they are completed prior to scheduled date.
• Answers the phones
• Relays messages to and from the providers to the patients.
• Ensures the end of day reconciliation is complete each night before close.
• Preform basic clerical duties as required.
• Initiates and process prior authorization requests from healthcare providers for medical procedures and surgical services.
• Verify patient insurance coverage and benefits to determine requirements for prior authorization and collaborate with Artesia General providers, insurance companies, and patients to facilitate efficient authorization processes.
• Maintain accurate records of authorization requests, approvals and denials
• Communicate with providers and front-end office, insurance companies, and patients regarding authorization status, requirements and appeals.
• Prepare and submit 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.

ADDITIONAL RESPONSIBILITIES:

• As assigned.

KNOWLEDGE/SKILL/ABILITIES:

• Knowledge of office equipment and ability to handle multi-time telephones.
• Basic math and computer skills.
• 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.

AGE-RELATED COMPETENCIES: Demonstrates the basic knowledge and skills necessary to identify age-specific patient needs appropriate for this position.Information Management: Treats all information and data within the scope of the position with appropriate confidentiality and security.Risk Management/Quality Management/Safety: Cooperates fully in all Risk Management, Quality Management, and Safety Activities and Investigations.MINIMUM POSITION QUALIFICATIONS:

• Education – High school diploma or equivalent.
• Work Experience – Customer service, familiar with using computers. Experience in a healthcare setting preferred. Previous experience in medical billing and insurance authorization preferred. Good communication skills required, bi-lingual capabilities preferred.
• Ability to work overtime to meet deadlines or handle urgent authorization requests.
• License/Certification – N/A
• Training: – N/A

ENVIROMENTAL CONDITIONS: Work environment consists of daily patient contact, which may include exposure to blood, or other body fluids.

Artesia General Hospital