Scheduled Weekly Hours: 40

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Under the general direction of the Clerical Supervisor and within established departmental and hospital guidelines maintains responsibility as liaison between insurance companies and the hospital for prior authorization requests. Extensive involvement with physician offices/staff in order to obtain and provide accurate exchange of information. Maintains hard copy records including periodic purging as required. Responsible for verifying and/or obtaining insurance preauthorization for scheduled outpatient examinations, including website and telephone requests. Keeps up to date on insurance requirements and works with schedulers/technologists to obtain correct authorizations. May be required to complete additional tasks per departmental needs.

Education/Training:

High School Diploma or equivalent

Licenses/Certification: N/A

Required Qualifications and Skills:

• Minimum of 1 year of experience in customer service industry.
•   Must be well organized and able to work independently
• able to interact in a pleasant manner, either on the telephone or in person with patients and family members
• command of verbal and written English
• positive interpersonal communication skills
• Computer literate
• Detail Oriented

Preferred Qualifications and Skills:

• Experience working with Cerner
• Experience in a Hospital setting
• Medical terminology
• Previous experience working with insurance pre-authorizations
• Experience with records correspondence
• Extensive HIPAA knowledge

Essential Job Functions:

• Verify insurance authorization for scheduled exams by using the Internet as well as telephone communication.
• Work with schedulers/technologists in verifying correct exam is ordered for presenting problem.

• Check prior day’s schedule for additional studies performed that were not authorized.

• Contact physician’s office to obtain authorization for additional studies performed – to be done in a timely manner per each insurance filing requirements.

• Verify eligibility and pre-authorization requirements for scheduled patients having exams that require prior authorization, especially from offices outside of the health system.

• Research and rectify issues presented from coding/billing in regards to prior authorization.

• Responsible for general and secondary tasks as needed or assigned.

Other duties: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

AGE AND DIVERSITY RELATED CRITERIA: Consistently treats patients, colleagues and visitors with the dignity and respect, while being sensitive to the differing needs of all age groups, backgrounds, characteristics and cultures.

ABILITY TO FULFILL JOB EXPECTATIONS: Must have the ability to the perform essential functions of the position, including required work hours, locations and physical demands, without posing a direct threat to the health and safety of themselves or other individuals in the work place, and with or without reasonable accommodation.

PHYSICAL DEMANDS:

Sit for long periods of time, repetitive movements, use of hands to handle, control, or feel objects, tools, or controls. See details of objects that are less than a few feet away, speak clearly so listeners can understand, understand the speech of another person, use fingers to grasp, move, or assemble very small objects.  Ability to use office equipment such as telephone, computer, scanner, fax machine and copy machine without difficulty. 

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Salary Range: $19.85-$30.05

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Salary Range Details

The pay range displayed on each job posting reflects the anticipated range for new hires. A successful candidate’s actual compensation will be determined after taking factors into consideration such as the candidate’s work history, experience, skill set, and education. This is not inclusive of the value Sturdy Health’s benefits package (if applicable), which includes among other benefits, healthcare/dental/vision and retirement. For annual salaries this is based on full-time employment.

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Sturdy Memorial Hospital is an equal employment opportunity employer. There is no discrimination because of race, color, creed, age, gender, sexual orientation, national origin, veteran status or disability.