Location: Ann Arbor
Posted on: January 13, 2022
POSITION DESCRIPTION: This position is responsible for all
aspects of the authorization/pre-certification process. May perform
Medical Receptionist duties as necessary. ESSENTIAL JOB FUNCTIONS:
Obtains pre-certifications, insurance authorizations and testing
for medical procedures. Monitors inbox. Obtains urgent
authorizations same day, next day. Verifies correct procedural and
diagnostic codes and insurance verification. Generates
authorization information for physicians, patients and health
plans. Acts as a liaison among providers, staff, health plan
administrators and hospital representatives. Relays clinical
information to health plan case managers for special procedure
pre-certification and out-of-plan or out-of-network referrals;
monitors authorizations or denials and follows up as necessary.
Communicates referral status to staff and physicians; ensures that
authorizations have been processed accurately and in a timely
manner to coincide with patient treatment plan. Assists offices in,
resolving billing discrepancies and any other
referral/authorization issues. Answers incoming calls. Scans and
files documents. Supports other offices, attends required meetings
and training, and participates in committees as requested. May
perform Medical Reception duties as necessary. Assists with special
projects and assumes additional duties as assigned. ESSENTIAL
QUALIFICATIONS: EDUCATION : Undergraduate degree or Associate's
degree in health care or a related field and specialized training
or equivalent combination of education and experience.
CREDENTIALS/LICENSURE : None MINIMUM EXPERIENCE : 4 years'
experience with insurance referrals, prior authorization or other
relevant medical office experience. POSITION REQUIREMENTS
(ABILITIES & SKILLS): Knowledge of medical terminology and
procedures at the level needed to perform responsibilities.
Proficient knowledge of major health plans and insurance processes.
Excellent written (legible), verbal and face-to-face communication
skills, including ability to effectively explain relevant insurance
information to patients, as well as communicate with insurance
plans and internal customers. Proper phone etiquette.
Proficient/knowledgeable in patient care procedures and
organizational policies related to position responsibilities.
Service-oriented; responsive to customer needs and courteous in
approach. Proficient in operating a standard desktop and
Windows-based computer system, including but not limited to,
electronic medical records, NextGen , PowerChart , EPIC, Microsoft
Word /Excel/Outlook, intranet and computer navigation. Ability to
compute mathematical calculations. Ability to work independently
and collaboratively in a team-oriented environment; professional
and friendly demeanor. Ability to work effectively with various
levels of organizational members and diverse populations including
IHA staff, patients, family members, vendors, outside customers and
couriers. Ability to cross-train in other areas of practice in
order to achieve smooth flow of all operations. Good organizational
and time management skills to effectively juggle multiple
priorities and time constraints. Ability to exercise sound
judgement and problem-solving skills. Ability to handle patient and
organizational information in a confidential manner. Ability to
travel to other office/practice sites and meeting and training
locations. Successful completion of IHA competency-based program
within introductory and training period.
Keywords: IHA, Ann Arbor , Authorization Specialist, Other , Ann Arbor, Michigan
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