Freedom Spine & Pain Center
POSITION: Prior Authorization Coordinator
DEPARTMENT: Office
CLASSIFICATION: Non-exempt
BENEFITS: Health Insurance, Dental, Vision, Life/AD&A, STD, LTD, 2-weeks PTO, and 8 Paid Holidays
SUMMARY: Coordinates the authorization/pre-certification prior to patients’ scheduled procedure/surgery to include following up on authorizations and insurance appeals.
ESSENTIAL DUTIES:
- Coordinates prior-authorizations for procedures, imaging orders, or medications by verifying the correct authorization form, gathering all necessary information to complete the authorization form, and submitting the authorization form to the insurance plan.
- Identifies any need for peer-to-peer, letter of medical necessity or other documentation to obtain treatment pre-certification and notify provider immediately.
- Interacts with patients and third-party insurance companies to secure retroactive insurance coverage and authorizations, coordination of benefits, and/or single case agreements for out of network patients, where applicable.
- Enters authorization or pre-certification information into the insurance verification system to ensure all documentation is entered timely and accurately and all insurance requirements are met.
- Tracks and follows-up on all pending authorizations or requests for additional information depending upon payer guidelines to expedite the claims process.
- Notifies appropriate staff of approved medications or if patient has no coverage or patient’s benefits do not cover a certain procedure or medication; and makes the appropriate updates to the verification system.
- Obtains and secures referrals are on file, obtains authorization renewals, verifies physician written orders are active, and ensures certification of medical necessity is in place.
- Works closely with Billing and Clinical Team to assist patients with estimate questions and/or balance inquiries, provides patient estimates for procedures, and identifies account issues and trends.
- Provides administrative support for the medical office by answering incoming calls and text messages, checking and processing incoming mail, maintaining office equipment, checking and answering daily emails.
- Performs other duties as required.
EDUCATION:
Must have a High School Diploma or equivalency.
EXPERIENCE:
Must have at least three (3) years of surgical prior-authorizations experience.
LICENSES/CERTIFICATIONS:
N/A
SKILLS:
Must have the following skills and/or abilities:
- Knowledge of medical classification systems such as ICD-9, ICD-10, CPT, DSM-IV, and HCPCS.
- Working knowledge of medical insurance plan processes such as benefits verification and referral/prior authorization.
- Working knowledge of third-party payers such as HMOs, PPOs, Medicare, Medicaid, and Worker’s Compensation.
- Working knowledge of ERAs and EOBs.
- Working knowledge of payer specific/LCD guidelines.
- Understanding of health plan benefits (deductibles, copays, coinsurance) and eligibility verification.
- Working knowledge of EMR systems such as eClinicalWorks or Athena.
- Strong computer and keyboard skills which includes MS Word and Excel, ten-key number pad or calculator by touch.
- Excellent interpersonal and communication skills (both written and oral) when working with patients or co-workers.
- Excellent customer services skills to interact with patients in a positive, cooperative, and courteous manner.
PHYSICAL ACTIVITIES:
- Constantly sits or stands within a given day while conducting work functions such as inputting data, talking on the phone with patients/insurance representatives, responding to insurance inquiries, operating keyboard, and interacting with patients and coworkers.
- Constantly using of fingers and hands when typing, using a 10-key number pad, handling pens/pencils, forms/paper, telephone, tools, or other computer or office equipment.
- Frequently lifts, transfers, pushes, or pulls up to 15 lbs. of files, supply boxes, or other small office equipment.
- Hears average or normal conversations and receives ordinary information through verbal communications.
- Average, ordinary visual acuity necessary to utilize the computer or other office machinery, and to read or write instruction manuals or other documents.
- Frequently move about the office which may include climbing stairs, stopping, kneeling, and/or bending.
WORKING CONDITIONS:
Medical office atmosphere located inside a building with some hazardous or significantly unpleasant conditions. Minimal exposure to medical equipment, such as autoclaves, stethoscopes, EKG electrodes, AEG machines, scales, and hemoglobin testing machines.
CONCEPTUAL/INTELLECTUAL ACTIVITIES AND OTHER REQUIREMENTS
- Frequently convey detailed or important instructions or ideas accurately, clearly, and/or quickly.
- Understand, remember, follow, and exchange basic instructions, information, and guidelines.
- Technology savvy with the ability to learn new software quickly.
- Project a courteous, professional and positive demeanor with co-workers and patients while performing essential duties.
- Organize thoughts and ideas into understandable terminology.
- Dependable attendance and punctuality are necessary to perform the essential job duties.
- Ability to apply common sense reasoning and decision-making to carry out detailed, involved billing transactions and to resolve problems involving several concrete variables.
- Ability to maintain self-discipline and focus on relevant matters in order to timely complete important tasks.
- Understand opposing points of view on highly complex issues and to negotiate and integrate different viewpoints.
- Listen to others and objectively considers others’ ideas and opinions, even if they conflict with one’s own.
This job description in no way states or implies that these are the only duties to be performed by the employee in this position. Requirements are representative of minimum levels of knowledge, skills, and/or abilities. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Additionally, this document does not create an employment contract, implied or otherwise.
Benefit Conditions:
- Waiting period may apply
- Only full-time employees eligible
Work Remotely
Job Type: Full-time
Pay: $14.00 - $19.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Schedule:
Supplemental pay types:
Experience:
- Surgical Authorizations: 3 years (Required)
Education:
- High school or equivalent (Required)
Location:
- Boerne, TX 78006 (Required)
Application Question:
- Please list a few times in the next 1-2 weeks you would be available for a call.
Work Location: In person