Network Prior Authorization Representative
Company: St. Luke's University Health Network
Location: Allentown
Posted on: June 22, 2022
Job Description:
St. Luke's is proud of the skills, experience and compassion of
its employees. The employees of St. Luke's are our most valuable
asset! Individually and together, our employees are dedicated to
satisfying the mission of our organization which is an unwavering
commitment to excellence as we care for the sick and injured;
educate physicians, nurses and other health care providers; and
improve access to care in the communities we serve, regardless of a
patient's ability to pay for health care.The Network Prior
Authorization and Referral Specialist is responsible for the
coordination of prior-authorizations and referral process for
patients being referred for specialty care, diagnostic procedures,
and surgery. Performs scheduling, insurance verification, obtaining
pre-authorizations, and referrals. Ensures notification of
reimbursement to physicians, nurses, financial clearance staff, and
patients prior to services being rendered. JOB DUTIES AND
RESPONSIBILITIES:
- Obtains prior-authorizations and referrals from insurance
companies prior to procedure or testing utilizing online websites
or via telephone.
- Monitors and updates current Orders and Tasks; managing Orders
through Allscripts and Epic to provide up to date and accurate
information.
- Provides insurance company with clinical information necessary
to secure prior-authorization or referral.
- Works in alignment with Central Scheduling and Pre Encounter
Departments.
- Obtains necessary electronic referrals needed from scheduled
specialty appointments.
- Obtains and/or reviews patient insurance information and
eligibility verification to obtain prior-authorizations for
diagnostic testing, medications, injections, DME, and
surgeries.
- Request retro-authorizations when needed.
- Communicates with patient regarding the visit and
prior-authorization process.
- Provides support to physician group and community practices
with utilization issues.
- Works with community practices to obtain
prior-authorizations.
- Communicates with practices when prior-authorization is unable
to be obtained and requires peer-to-peer and/or different
study.
- Documents in all systems prior-authorizations to ensure proper
reimbursement. PHYSICAL AND SENSORY REQUIREMENTS: Sitting for up to
8 hours per day, 3 hours at a time. - Consistent use of hands and
fingers for typing, telephones, data entry, etc. - - Occasional
twisting and turning. - Uses upper extremities to lift and carry up
to 15 pounds. - - Stoops, bends, and reaches above shoulder level
to retrieve files. - Hearing as it relates to normal conversation.
- Seeing as it relates to general vision. - Visual monotony when
reading reports and reviewing computer screen. EDUCATION: High
School diploma or Equivalent Required TRAINING AND EXPERIENCE: One
to two years of experience in medical billing office, medical
setting or insurance company. - Working knowledge of medical
business office procedures and basic accounting and detailed
understanding of ICD-10 and CPT codes. Strong knowledge of
regulatory standards and compliance requirements. - - Previous
pre-certification experience helpful. - Previous Medical Assistant
experience highly desirable. Full time, 1st Shift, Mon-Fri. No
nights, no weekends, no holidays.Flexible start times: 8 AM- 4:40
PM, 8:30 AM- 5:00 PM, 9 AM- 5:30 PM, or 10:30 AM- 7:00 PM. Remote
or hybrid work is available after training on site, approval for
remote is at the manager's discretion. Please complete your
application using your full legal name and -current home address.
-Be sure to -include -employment history for -the past seven (7)
years, including your present employer. - Additionally, you are
-encouraged to upload a current resume, including all work history,
education, and/or certifications and -licenses, if applicable. -It
is highly recommended that you create a profile at the conclusion
of submitting your first application. -Thank you for your interest
in St. Luke's!!
Keywords: St. Luke's University Health Network, Allentown , Network Prior Authorization Representative, Other , Allentown, Pennsylvania
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