US Heart and Vascular
US Heart and Vascular is in need of a Prior Authorizations Specialist to join our team in Franklin, TN.
Responsibilities • Ensures timely and accurate insurance authorizations are in place prior to services being rendered. • Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt. • Responsible for verification and investigation of pre-certification, authorization, and referral requirements for services. • Coordinates and supplies information to the review organization (payer) including medical record information and/or letter of medical necessity for determination of benefits. • Collaborates with designated clinical contacts regarding encounters that require escalation to peer-to-peer review. • Communicates with patients, clinical partners, financial counselors, and others as necessary to facilitate the authorization process. • Appropriately prioritizes workload to ensure the most urgent cases are handled in a timely manner. • Completes accurate documentation in all applications. • Follows departmental policies and procedures, when necessary, authorization is not obtained before the service date. • Answers provider, staff, and patient questions surrounding insurance authorization requirements. • Handles escalated authorization requests as needed. • Provides team mentorship as needed. • Works other departmental tasks as needed.
Requirements • Familiarity with medical office procedures and billing practices • Proficient in clinical documentation review for alignment with insurance authorization requirements • Responsible for compliance with all regulatory requirements and/or guidelines. These requirements/guidelines include, but are not limited to: OSHA, HIPAA, Federal Fraud and Abuse laws. • Computer skills - good working knowledge of MS office • Provide professional service to direct customers of USHV in all interactions. • Manage daily tasks to ensure business needs are consistently met. • High School Diploma or equivalent required • Associate's degree in healthcare administration or business administration preferred • A minimum of 3-5 years' experience in the same role, or related field in a healthcare setting is required. • eCW experience a plus.
About Tucson
Located in PIMA county, Tucson is considered the soul of the Sonoran Desert and the flavor of the Southwest, making it a hotspot for outdoor enthusiasts. Join a community rich in food, arts, culture, and the great outdoors. Tucson International Airport (TUS) offer nonstop service to 20+ destination airports, with convenient one-stop connections.
Responsibilities • Ensures timely and accurate insurance authorizations are in place prior to services being rendered. • Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt. • Responsible for verification and investigation of pre-certification, authorization, and referral requirements for services. • Coordinates and supplies information to the review organization (payer) including medical record information and/or letter of medical necessity for determination of benefits. • Collaborates with designated clinical contacts regarding encounters that require escalation to peer-to-peer review. • Communicates with patients, clinical partners, financial counselors, and others as necessary to facilitate the authorization process. • Appropriately prioritizes workload to ensure the most urgent cases are handled in a timely manner. • Completes accurate documentation in all applications. • Follows departmental policies and procedures, when necessary, authorization is not obtained before the service date. • Answers provider, staff, and patient questions surrounding insurance authorization requirements. • Handles escalated authorization requests as needed. • Provides team mentorship as needed. • Works other departmental tasks as needed.
Requirements • Familiarity with medical office procedures and billing practices • Proficient in clinical documentation review for alignment with insurance authorization requirements • Responsible for compliance with all regulatory requirements and/or guidelines. These requirements/guidelines include, but are not limited to: OSHA, HIPAA, Federal Fraud and Abuse laws. • Computer skills - good working knowledge of MS office • Provide professional service to direct customers of USHV in all interactions. • Manage daily tasks to ensure business needs are consistently met. • High School Diploma or equivalent required • Associate's degree in healthcare administration or business administration preferred • A minimum of 3-5 years' experience in the same role, or related field in a healthcare setting is required. • eCW experience a plus.
About Tucson
Located in PIMA county, Tucson is considered the soul of the Sonoran Desert and the flavor of the Southwest, making it a hotspot for outdoor enthusiasts. Join a community rich in food, arts, culture, and the great outdoors. Tucson International Airport (TUS) offer nonstop service to 20+ destination airports, with convenient one-stop connections.