WorkSource Oregon Pre-Authorization Specialist in BEND, Oregon
Job Title: Pre-Authorization Specialist Department: Pre-Authorization Location(s): Bend, Oregon Hours: Monday - Friday, 8:30 am - 5:30 p.m. Travel Required: None Position Type: Regular Full Time Resume Required: No Date Posted: 06/08/2018 Posting Expires: Open until filled Job Summary: Expedites the administrative requirements for patient referrals, dealing directly with health plans and or referring physicians offices, ensuring proper notification / authorization have been obtained in a timely manner. ESSENTIAL DUTIES, RESPONSIBILITIES, AND COMPETENCIES: This position requires a high level of attention to detail and a low error rate, as the consequences of even a minor mistake can be detrimental as decisions may then be based on erroneous information. This position requires regular, reliable attendance. 1.Verifies and validates insurance pre-authorization number with appropriate carrier to ensure prior approval requirements are met. 2.Confirms facility matches the authorization. 3.Confirms the CPT code is specific to exam. 4.Communicates information effectively both verbally and in writing. 5.Contact person for procedures that are changed or added during a patient's appointment so appropriate authorization can be made while the patient is here. 6.Reviews all scheduled patients for Medicare coverage and checks reason code to determine if a Medicare waiver is needed. a.Notes in scheduling screen when a Medicare waiver is needed. 7.When an e-mail is received from the scheduling department regarding add-on studies, authorization is obtained when needed and in a timely manner. 8.Verifies authorizations are in place for all PET scans prior to arrival. 9.Contacts referring physician's office with insurance denials and works with them to make any necessary corrections. 10.Contacts patient prior to services being rendered if an authorization is denied or has not yet been obtained to advise them of the reason(s) and to advise them to our fees for the procedure(s). 11.Ability to get along with others and work cohesively with co-workers. Education and Experience: One year certificate from college or technical school; or three to six months related experience and/or training; or equivalent combination of education and experience.