LITTLE ROCK, AR 72202
Perform eligibility and benefit analysis for all treatment and exams.
Obtain authorization as needed from referring physician office and verify for accuracy.
Completes verification, benefit analysis, and authorization for specified procedures/appointments directly with the insurance payer.
Communicate schedule discrepancies with appropriate department.
Obtains accurate clinical history for appropriate pre-authorized requests.
Provide necessary clinical information and pertinent demographic information to insurance company either via web or phone call.
Requires knowledge of appropriate CPT for each procedure.
Communicate with referring office or hospital department when a discrepancy arises with procedure scheduled.
Document appropriate authorization number and valid dates for each procedure.
Begin work on all pre authorizations scheduled out 30 days.
Communicates payer requirement changes to the pre access lead or management staff.
Monitor insurance company protocols for authorization changes.
Review patient schedule to ensure appropriate pre-certifications are obtained based on medical treatment plan and exams.
Follow-up as needed with scheduling conflicts or problems.
Provide support and assistance with claims denial due to pre-authorized issues.
Documents accounts appropriately.
Maintains strict patient confidentiality at all times.
Promotes cooperation and teamwork
Speaks clearly and concisely in a courteous and friendly tone of voice.
Listens carefully to the caller, answers questions and seeks assistance from others as needed.
Interacts with managers, co-workers, and other hospital personnel in the sharing of work-related objectives and the need for clarification and/or process improvement.
Demonstrates a personal commitment to continuous quality improvement through active participation.