Posted on: November 22, 2021
Westfield Plastic Surgery Center is looking for a
Pre-Authorization Specialist to add to our growing team. The right
candidate will be responsible for prior-authorization of hospital
surgical and ancillary services. Primary functions include:
insurance eligibility verification, benefit and out of pocket
liability determinations, pre-determination and pre-certification /
authorization of surgeries and/or other clinical services performed
at Westfield Plastic Surgery Center. Coordinates with surgical
centers and hospitals to schedule surgeries. Work closely with our
team in living out our mission statement in a professional manner
while working to exceed patient's expectations.
Maintains excellent communication and positive rapport with all
points of contact both internally and externally, documenting
pertinent discussions and details of correspondence in all
applicable systems to provide tracking and point of reference.
Responsible for obtaining and communicating accurate benefit
information and eligibility, pre-determination/pre-authorization as
well as detailed benefit and patient liabilities per insurance
company requirements and established timeframes, i.e., online vs.
telephone to ensure credible coverage and benefits are in
Responsible for monitoring incoming additions, revisions, and
cancellations as well as clinical requests for authorization and
Scheduling surgical procedure in-office, with outpatient ambulatory
surgical centers and hospitals. Self-motivated to work surgical
cases and identifying any need to contact patient to obtain
additional registration or demographic information, as well as
determining any change to authorization and/or coverage
Routinely monitors cases pending or not yet started/complete. Being
attentive to payer specific processing time frames or clinical
Initiates expedited reviews with payers when necessary to ensure
authorization is in place prior to, or at the time of service and
communicates late notifications or risk of no auth situations to
Office manager as soon as identified.
Identifies and takes steps to ascertain and provide necessary
clinical documentation to meet payer requests as needed for
authorization or pre-determination needs.
Responsible for data entry of documentation on patient accounts in
the computer system, including completion of a surgery booking
sheet, and all forms included in the surgical booking process.
Communicates in a positive and professional manner with the patient
/ guarantor on any financial issues, including notification of
money owed day of service for in-office procedures.
Meets productivity and quality standards, following all
documentation guidelines as communicated by Westfield Plastic
Other Duties: This job description incorporates the essential
functions and duties required for this position. However, other
duties may be required and assigned at times and as determined by
the office manager in order to meet the needs of Westfield Plastic
High school diploma or equivalent.
Minimum of 2 years' experience working in a hospital or clinic
billing environment, preferably focused on preauthorization,
Knowledge of insurance terms and reimbursement procedures.
Must be detail oriented.
Knowledge of Explanation of Benefits (EOB), preferred.
Excellent verbal and written communication skills required.
Excellent telephone etiquette.
Keywords: CareerLink, Omaha , Prior-Authorization Specialist, Other , Omaha, Nebraska
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