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The Role
Verifies insurance eligibility and benefits, identifies payer authorization requirements, submits and tracks prior authorizations, communicates approvals or denials, and supports timely patient financial clearance. The role documents payer policies, monitors Medicare guidelines, manages authorization work queues, collaborates with clinical and administrative teams, and analyzes denial trends to improve revenue cycle processes.
Summary Generated by Built In
QUALIFICATIONS
Education
- High school diploma or equivalent
- Associate degree preferred
Experience/Skills
- Has one year patient access, medical billing, or prior authorization experience
- Possesses medical terminology and CPT/HCPCS/ICD-10 coding knowledge
- Demonstrates proficiency in Meditech and MS Excel
- Professionally collaborates with staff at various levels throughout the organization, including, but not limited to: Physician Practices, HIM, Information Systems, Patient Financial Services and Clinical Directors
- Works efficiently with minimal supervision
- Remains flexible to accommodate staffing shortages in the Patient Access department
Required Licenses/Certifications
- N/A
Working Conditions
- Works in a well-ventilated, well-lit general office environment
- Works well under pressure with attention to time constraints
ROUTINE RESPONSIBILITIES
Behavioral Expectations
- Consistently complies with established Behavioral Expectations
Essential Duties
- Verifies insurance eligibility and benefits directly with payer or on payer Website prior to starting the authorization process
- Identifies and documents each payer policy and procedure regarding coverage and items that require prior approval
- When applicable, verifies that Medicare diagnosis support service and frequency guidelines are not exceeded
- Manages daily work queues to ensure prior authorizations are submitted timely and accurately
- Ensures that notification of authorization approval or denial is communicated timely to the ordering physician’s office and to the patient
- Follows up with payers to check status of previously submitted prior authorizations
- Works directly with Director of Revenue Cycle to identify trends in denials and opportunities for improvement in the authorization process
- Implements a payer-specific check list for eligibility, benefits, and authorization to cover pre-financial clearance
Full time/Day shift
80 hours/Biweekly
Skills Required
- High school diploma or equivalent
- One year of patient access, medical billing, or prior authorization experience
- Knowledge of medical terminology
- Knowledge of CPT, HCPCS, and ICD-10 coding
- Proficiency in Meditech and Microsoft Excel
- Ability to collaborate professionally across organizational departments
- Ability to work efficiently with minimal supervision
- Associate degree
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The Company
What We Do
Since 1918, our hospital has been serving the Wabash Valley community. We are committed to providing exceptional care experiences to our patients and visitors through our dedication to excellence in healthcare and customer service.
