Specialist-Authorization Denial
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Job Location:
Memphis, TN - USA
Monthly Salary:
Not Disclosed
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
|
| Reviews clinical information and supporting documentation for outpatient or Part B services authorization denials to determine and perform retro authorizations reconsiderations or appeal actions to defend the revenue. Performs other duties as assigned. |
- Obtain and review treatment/therapy plan orders for medical necessity and appropriateness according insurance medical policy/FDA/NCCN guidelines and requirements.
- Research insurance company medical policies medical literature and compendiums to determine eligibility for services. Utilize multiple healthcare websites
- Responsible for tracking obtaining and extending authorizations from various carriers in a timely manner
- Responsible for completing the Insurance Verification process
- Works closely with physicians and clinic staff obtain authorizations to promote positive patient outcomes timely treatment and positive reimbursement
- Understands and complies with regulatory requirements by specific insurance companies and facilitates compliance by maintaining awareness of guidelines and ensuring compliance through communication and documentation to appropriate staff.
- Reviews assesses and evaluates all authorization denial communications received in order to optimize reimbursement
Education
| Minimum Required |
3 5 years of business experience in a healthcare environment with 2 of those years being in a clinical setting. Preferred/Desired 5 years of business experience in a healthcare environment with at least 3 years payer specific experience. 3 years clinical experience in a clinical care setting Pre-certification experience desired. Education
Skill in communicating clearly and effectively using standard English in written oral and verbal format to achieve high productivity and efficiency. Skill to write legibly and record information accurately as necessary to perform job duties. Strong organizational skills. Ability to type and/or key correctly Preferred/Desired Associates degree or 2 years of college level courses. Training Minimum Required Requires critical thinking and judgement. Preferred/Desired Must demonstrate the ability to appropriately use standard criteria established by payers. Special Skills Excellent customer service and communication skills. Ability to speak articulate and be understood clearly. Minimum Required Ability to read and understand medical policies compendiums LCDs and FDA guidelines. Must be able to multi-task and be flexible. Advance computer literacy skills and problem solving skills. Ability to deal with confrontational issues and high stress situations with patients family and physicians. Preferred/Desired Knowledge of oncology pre-certification requirements and guidelines. Licensure Preferred/Desired Pharmacy Tech CHAA RHIT LPN RN |
Required Experience:
IC
Key Skills
- Sales Experience
- Crane
- Customer Service
- Communication skills
- Heavy Equipment Operation
- Microsoft Word
- Case Management
- OSHA
- Team Management
- Catheterization
- Microsoft Outlook Calendar
- EHS
About Company
Baptist Memorial Hospitals provide compassionate, close-to-home care for patients in the Mid-South. Learn about our medical clinics and health care services.
