Patient Access Coordinator (Pre-Authorization)
Patient Access Coordinator (Pre-Authorization)
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Job Description
AIM OF THE POSITION
The Patient Access Coordinator is responsible for requesting authorization for all applicable incoming orders. This process includes understanding of payers medical policies for our services collecting and reviewing all the necessary documentation required to submit prior authorization contacting the ordering physician or their office for additional information if applicable completing the required authorization submission forms within allotted timeframes and followup with the payor to obtain an authorization determination. When applicable the PA Coordinator will also submit a Prior Authorization appeal if criteria is met but the PA was denied erroneously.
POSITION WITHIN THE ORGANIZATION
1. Customer Care Sales Commercial and external vendors
2. Cooperates with all departments across the organization
ESSENTIAL DUTIES AND RESPONSIBILITIES
Reviews incoming orders to determine if authorization is required
Reviews documentation from ordering physician for completeness to meet the medical policies of payors and work them in priority dependent on allotted timeframes per payer as the time can vary.
Contacts ordering physicians office to obtain missing documentation when applicable or to meet timeliness of the submissions
Communicate with physician offices and/or sales team for assistance with authorization submissions when applicable
Verifies diagnosis code on order in line with current ICD 10 requirements
Completion of authorization forms via paper or online
Submit authorizations to payors via fax through payor portal or third party vendor with all required documentation to maximize success in achieving approvals
Log authorization actions within the billing system for tracking
Follow up on all open authorization submissions including those submitted by the third party vendor
Notify billing staff and document account when authorization determination is received
Additional tasks as needed
The above listing represents the general duties considered essential functions of the job and is not to be considered a detailed description of all the work requirements that may be inherent in the position.
KEY CONTACTS
Internal: This position may interface with various departments within the company.
External: Clients and Payors
EDUCATION AND EXPERIENCE REQUIREMENTS
EDUCATION:
High School diploma or general education degree
1 years related experience preferable
KNOWLEDGE SKILLS AND ABILITIES (KSAS)
Specific Knowledge Required:
Knowledge: Comprehension of a body of information acquired by experience or study. Skill: A present observable competence to perform a learned activity.
Ability: Competence to perform an observable behavior.
Medical PreAuthorization knowledge/experience 1 years
Knowledge of CPT and ICD 10 codes
Previous medical billing experience preferred
Ability to read and understand medical payer policies as well as pathology reports
Ability to work with sensitive and confidential information
BEHAVIOURAL COMPETENCIES/DESIRED SKILLS
Must be able to work in a fastpaced environment
Must have strong organizational skills and attention to detail
High degree of accuracy
Manage Multiple tasks independently
Excellent problem resolution
Excellent customer service skills
Outside the Box thinker
Other Skills necessary: Analytical thinking thoroughness good research skills and strong verbal/written communication.
PRIVACY NOTICE: To review the California privacy notice click here: Employees must not be classified as an excluded individual who is prohibited from participation in any Federal health care program.
WORKING ENVIRONMENT
Establishes ADA (Americans with Disabilities Act) requirements
ENVIRONMENT/SAFETY/WORK CONDITIONS
Working conditions (inside or outside the office)
General office environment. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Maintains a clean neat and orderly work area.
Adheres to Department Specific Safety Guidelines.
Standing sitting walking bending reaching manual manipulation and lifting up to 15 pounds.
TRAVEL
No travel is required.
OTHER DUTIES
Other duties as required by management
Required Experience:
IC
Employment Type
Full Time
