MAJOR RESPONSIBILITIES/ESSENTIAL FUNCTIONS
The primary job duties this position is responsible for achieving are listed in order of importance.
Position Summary:
Primary function is to perform telephone and or on-line authorization for routine services, contacting care providers, monitoring concurrent and discharged authorization. To perform online data entry and scanning of routine authorizations, continued stay authorization and denials.
The following are essential job accountabilities:
- Assists in gathering information needed to determine continued clinical authorization. Provides data entry, as appropriate.
- Contacts case managers/ providers with authorization, denial and appeal process information. Assists in educating and acts as a resource to primary care and specialty providers.
- Works closely with case managers, billers and support team to accomplish authorization/ verification.
- Obtains authorization from health plan, IPA, medical group's case managers.
- Works and resolve pended claims received without prior authorization.
- Serve as subject matter expert for assigned payor (s) as directed by patient access leadership while demonstrating broad knowledge of all payors in the hospital portfolio.
- Performs telephone and/ or on-line authorization for routine services, contacting care providers, monitoring concurrent and discharged authorization.
- Performs online data entry and scanning of routine authorizations, continued stay authorization and denial
Other Position Accountabilities:
- Works effectively with patient access peers and other departments.
- Delivers exemplary customer service in accordance with hospital expectations / guidelines.
- Ability to work with high degree of confidentiality.
- Receive incoming mail with authorizations for extended stays.
- Answer incoming customer service calls.
- Provides support to Revenue Cycle work Team, as assigned.
- All other duties as assigned.
Working- Conditions:
- Regularly exposed to the risk of contagious and bloodborne diseases Subject to varying and unpredictable situations.
- Exposure to unpleasant elements (accidents, injuries, illness) Emergency and crisis situations.
- Subject to irregular hours
- Occasional pressure due to multiple calls and inquiries
- Occasional exposure to radiation hazards, radioactive substances and biohazardous material
JOB QUALIFICATIONS
Minimum Education (Indicate minimum education or degree required.)
- High School diploma or GED
Preferred Education (Indicate preferred education or degree required.)
Minimum Work Experience and Qualifications (Indicate minimum years of job experience, skills or abilities required for the job.)
- 2 years of billing experience for a healthcare facility
- Ability to communicate effectively verbally and in writing.
- Must be able to work in a union environment.
Preferred Work Experience and Qualifications (Indicate preferred years of job experience, skills or abilities required for the job.)
Required Licensure, Certification, Registration or Designation (List any licensure or certification required and specify name of agency.)
- Current Los Angeles County Fire Card required (within 30 days of employment)
- Assault Response Competency (ARC) required (within 30 days of hire)
