Prior Authorization Coordinator (520)

Category Patient Financial Services - 8210 Description

JOB SUMMARY:

• Answer calls from physician offices, hospitals and patients using exemplary customer service skills.
• Accurately enter required information (non-clinical and structured clinical data) into computer database.
• Review structured clinical data matching it against specified medical terms and diagnoses or procedure codes (without the need for interpretation) and follow established procedures for authorizing request or referring request for further review.
• Call back providers with precertification numbers as needed and file completed precertification requests as per established procedures.
• Validate benefit coverage per established procedures.
• Maintain patient confidentiality as defined by state, federal and company regulations.
• Establish effective rapport with support service staff, customers, clients, patients, families and physicians and actively support departmental strategic plans and ensure successful implementation.
• Maintain cooperative working relationships with all UM departments and providers.

QUALIFICATIONS:

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

• Associate can deliver required care/service appropriate to patients/customers.
• Initiates pre-certification process on all required outpatient hospital services and initiates rescheduling appointments as needed.
• Serves as a resource for inpatient certification as needed.
• Supports patient financial services with appeals and retro authorizations as needed.
• Collects and distributes appropriate registration and certification documents to pertinent hospital departments.
• Keys all required certification information into the hospital Meditech information system.
• Displays and maintains behavior which promotes good guest relations to patients, visitors, physicians, and co-workers.
• Initiates corrections of registration information upon review of admissions and services requiring pre-certification.
• Demonstrates ability to embrace and adapt to change and regularly initiates ideas to improve the efficiency and processes of the department.
• Performs similar or related duties as assigned.

EXPECTED BEHAVIORS:

• Evidence of good grooming and professional conduct.
• Good communication skills both oral and written.
• Ability to maintain composure under stressful situations.
• Possess a sense of responsibility, initiative, honesty and confidentiality.

Position Requirements

CERTIFICATION/LICENSE: Licensed Practical Nurse (LPN); Registered Nurse (RN)

ADDITIONAL LICENSURE/CREDENTIAL REQUIREMENTS: RN or LPN graduate of accredited nursing program. Previous experience in Utilization Management preferred.

ADDITIONAL EDUCATION AND EXPERIENCE REQUIREMENTS: RN or LPN graduate of accredited nursing program. Mandatory Continuing Education: Customer Service, Fire and Safety, Corporate Compliance (including Confidentiality), Infection Control, and education required by regulatory, accreditation bodies, scope of practice, and/or Hancock Regional Hospital.

Full-Time/Part-Time Full-Time Shift Days Sign-On Bonus Position Prior Authorization Coordinator (520) Number of Openings 1 Exempt/Non-Exempt Exempt Open Date 7/15/2020 Location Hancock Regional Hospital About the Organization Hancock Regional Hospital serves Hancock County and the surrounding areas as a full-service community hospital focused on primary care, patient comfort, and convenience.



Today, a highly skilled medical and professional nursing staff anchors Hancock Regional Hospital. We have a state-of-the-art surgery department, 24-hour emergency services, OB services, progressive and critical care, a geropsychology unit, home healthcare, occupational health, a transitional care unit, a total oncology program with a cutting-edge radiation oncology center, many private rooms, and a full complement of Inpatient and outpatient services.



Our Mission is to be a Caring Community Partner by healing, improving health and wellness, alleviating suffering, and delivering acts of kindness one person at a time. EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.

This position is currently accepting applications.

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