POSITION SUMMARY

Assists in coordinating the activities between scheduling, insurance verification, and pre-certification.  Collaborates with a variety of personnel and departments to ensure smooth clinic operations.   

PRIMARY DUTIES:

·         Verifies coverage and ensures all insurance requirements are met, as well as obtaining all prior authorization and/or referrals as appropriate prior to patient arrival.

·         Works with patients, physicians, charge capture specialists, and third-party representatives as necessary to obtain authorizations.

·         May require reviewing insurance company websites for assistance in determining which services require preauth.  Assures precertification is complete by direct call to insurance companies or by checking with physicians? offices.  May recommend re-scheduling of procedures if appropriate, so that pre-admit criteria may be met.

·         Obtains initial and subsequent insurance authorization and pre-certification for chemotherapy services, surgeries, outpatient testing, labs, and imaging.

·         Handles phone calls from patients regarding prior authorization questions for services ordered/scheduled.

·         Maintains a close working relationship with the site Patient Financial Counselor.

·         Stays current with insurance requirements.

·         Establishes priorities and accomplishes tasks in a timely manner.

·         Covers for and assists with other front office functions as requested.

·         Performs other duties as assigned.

·         Ability to work effectively under pressure with deadlines and exhibit an appropriate sense of urgency

·         The above statements reflect the general duties considered necessary to describe the principal functions of the job as identified, and shall not be considered as a detailed description of all the work requirements that may be inherent in the position.

EDUCATION AND EXPERIENCE

High school graduate or equivalent with courses in English and typing. Knowledge of insurance is required.   Demonstrated clerical skills required, preferably in a medical setting.  Completion of a Medical Secretary program may be substituted for experience.  Knowledge of insurance is required.

Must possess good oral and written communication skills, knowledge of medical terminology, type 45 wpm accurately, and be able to make simple math calculations.  Must be able to read and comprehend complex written material, operate office equipment including computer terminals, and observe rules of confidentiality.  Must become thoroughly familiar with specific hospital policies and procedures for admission and outpatient registration and with Medicare, Medicaid, and insurance pre-admission requirements and criteria.  Must become familiar with various insurance benefit plans, billing requirements, and hospital credit/collection policies.

WORKING CONDITIONS

Involves standing, sitting, and walking to various departments during each shift.  Some stress is created by ever-increasing volume and ongoing changes in prior authorization requirements imposed by government and commercial insurance companies.

GENERAL POSITION INFORMATION

The position is essential for the functioning of the St Joseph Cancer Center and Blood Institute.  The workload is generated by the number of patients the providers encounter each day.  Requires the ability to make decisions and judgments based on knowledge and experience. 

About St. Joseph Regional Medical Center

Connections working at St. Joseph Regional Medical Center