Tri-City Medical Center

AUTHORIZATION CLERK

2 weeks ago(1/6/2018 2:02 PM)
ID
2017-6458
FTE Status
Full-Time 1.0
Shift
Day
Cost Center/Dept
7090 - Primary Care Physician Clinic Vista
Work Schedule
8s

Overview

Position Summary:

The Authorization Clerk maintains the highest standards of customer service excellence. Responsible for a variety of duties including: registration, scheduling, exam order entry, record integrity, obtaining insurance authorization and referrals.

 

Major Position Responsibilities:

  • Responsible for verifying insurance coverage, eligibility, benefits, obtaining authorizations and pre-certs as required by the individual insurance company.
  • Obtains prior authorization for medication not on patients insurance formulary as requested by MD or MA, completes prior authorization transaction and notifies requesting MD or MA of any issues.
  • Processes all information required to complete referrals prioritizing by level of urgency and patient need.
  • Accurately enter notes regarding letters or correspondence from insurance companies regarding insurance authorization or other notifications.
  • Adheres to all medical practice policies and procedures.
  • Inform patients of referral status.
  • Answers telephone inquiries on status of referral.
  • Performs other duties as necessary.

Safety and Infection Control Responsibilities

  • Responsible to maintain a safe and clean work environment, including unit based specific safety and infection control requirements.

Qualifications: ESSENTIAL COMPETENCIES, KNOWLEDGE, & EXPERIENCE

  • Minimum 3-5 years Authorization Clerk experience in a hospital or medical office, required.
  • Ability to effectively present information in one-on-one and small group situations to patients, clients, and other employees of the organization.
  • Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
  • Must be able to interact and communicate with all levels of staff, physicians, patients and families in an effective manner.
  • Demonstrated knowledge of computer technology, including word processing, spreadsheet, and database.
  • Ability to work under stress and deal effectively and courteously with difficult people.
  • Ability to relate and work with people of all authority levels, ages, social and ethnic backgrounds.
  • Knowledge of medical procedure, as they apply to insurance authorizations.

Education:

  • High School diploma or GED required.

Each new hire candidate who is offered employment must pass a physical evaluation, urine drug screen and pre-employment background checks before starting work.

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