Prior Authorization Coordinator

Job Description

Job Description

Job Summary:

Responsible for obtaining Prior Authorizations primarily for Spine injections and Viscosupplementation. Liaison between Patients, Clinical staff, Insurance carriers, and OSG Prior Authorization Team to facilitate authorizations for patient procedures.

Educational Requirements:

• High school diploma required.
• College education or trade school preferred.
• Certified Professional Coding certification helpful.
• Minimum 1-2 years of experience working in a physician group practice billing department.

Qualifications & Skills:

• Minimum 1-2 years of experience working in a physician group practice billing department.
• Strong written and verbal communication skills.
• Knowledge of Anatomy & Physiology, and medical terminology.
• Current working knowledge of CPT, ICD10, and NCCI edits. Orthopaedics a plus.
• Experienced in working through Medicare, Commercial, and Medicaid clinical policies and reimbursement guidelines.
• Able to establish good relationships with insurance companies.
• Ability to perform multiple tasks simultaneously.
• Understands the sense of urgency in meeting the needs of our patients by quickly working through the authorizations.
• Comfortable using email and interacting with Internet applications.
• Knowledge of practice management and word processing software.
• Good analytical skills and an affinity for detail.
• Pleasant speaking voice and demeanor.
• Neat, professional appearance.

Responsibilities (including but not limited to):

• Verifies that Medical necessity guidelines for each insurance carrier are met, based on Provider documentation, and CPT/ICD10 codes assigned for procedures.
• Reviews the Prior Authorization requests in a timely manner in Athena Practice.
• Documents all pertinent information in the Patient chart.
• Refers the patient to the OSG Financial Counselor to determine financial responsibility, prior to procedure.
• Compiles updated Library of insurance carrier guidelines.
• Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by the practice.
• Has detailed knowledge of EHR, PM system, and other software platforms, as it relates to job functions.
• Attends all regular OSG Department meetings.
• Performs all other tasks and project assigned by the Billing Manager and/or the Director of Revenue Cycle Management.
• This job has no supervisory responsibilities.

Typical Physical Demands:

Position requires prolonged sitting, some bending, stooping, and stretching. Good eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment is also required. Employee must have normal range of hearing and eyesight to record, prepare, and communicate appropriate reports. Working conditions are similar to those of a typical office environment.