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.
- 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.