Insurance Authorization Jobs in Missouri (NOW HIRING)

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Job Location (Full Address):

601 Elmwood Ave, Rochester, New York, United States of America, 14642

Opening:

Worker Subtype:

Regular

Time Type:

Full time

Scheduled Weekly Hours:

40

Department:

910131 Thoracic Surgery

Work Shift:

UR - Day (United States of America)

Range:

UR URCA 205 H

Compensation Range:

$20.30 - $27.41

Responsibilities:

Performs complex secretarial and administrative duties, in a fast-paced environment with minimal direction and considerable latitude for independent judgment, in support of the clinical, educational, and academic programs for the Faculty of Thoracic and Foregut Surgery. Responsibilities include time and calendar management, telephone triaging and management, prior authorizations and information/data support.

ESSENTIAL FUNCTIONS

Patient Scheduling and Coordination of Care 40%

• Receives incoming patient telephone calls for surgeon(s) and nurse practitioner(s), managing and/or resolving various scheduling/coordination issues and answering questions as needed. Coordinate scheduling of patients at multiple practice sites; coordinates referrals for consults. Triages telephone calls from patients and referring physicians to surgeons, residents and nurse practitioners. Processes incoming referrals not generated within the UR system.
• Perform a needs assessment using information from the electronic medical record to ensure the appropriate appointment/procedure is scheduled with the appropriate provider; ensure that accurate patient demographic and current insurance information is captured; adhere to RIM protocols for record verification
• Manages the intake of new referrals through various sources, including the eRecord work queue, faxed referrals, and phone calls from outside providers. Enters faxed referrals into the record system.
• Ensures ancillary testing and other specialty referrals have been executed and results received and acted upon as needed. Investigates failure to receive such information, troubleshoot, resolve, and/or make recommendations to ensure delivery/receipt.
• Acquire insurance authorization for the visit and, if applicable, any testing; insurance authorization information will be entered in the Epic referral record for the patient, and referral records to any visits in which they are missing
• Provides patients with appointment and provider information, directions to the office location, and any educational materials if appropriate
• Documents all communications pertaining to the referral and/or insurance authorization in the notes section of the Epic referral record
• May perform complex appointment scheduling, linking referrals and ancillary services for the assigned specialty service
• Ability to make decisions that are guided by protocols and practices requiring some interpretation; maintains an expert-level understanding of the department/division
• Prior authorization functionality will be required for testing and services ordered by referred-to specialists, including but not limited to:
• Prepares and provides multiple, complex details and facts to the insurance carrier or worker's compensation carrier to obtain prior authorizations for standard and complex requests such as imaging, non-invasive procedures, sleep studies, etc.
• Communication of medical information to the insurance carrier
• Completes referral entry for all external referrals into Epic following approved protocols
• Coordinates any ancillary testing and obtains any outside records needed for patient appointment
• Demonstrates expert medical knowledge base with the ability to recognize urgent clinical situations
• Prioritize referral requests, responding immediately and expediting most urgent requests
• Review complex referral requests, evaluate them, and schedule them with the appropriate provider
• Works with providers and other clinical staff to establish the best care plan for the patient

Patient Scheduling (35%)

• Schedules appointments, tests, and surgeries, coordinating appointments, tests, and consults in preparation for surgery or further clinical work-up. Acquires prior authorizations for different X-rays and scans, which requires detailed filling out of specific request forms with patient's medical information outside of URMC. It also includes getting prior authorization for surgeries that may require speaking with insurance company nurses and giving specific health information from patients' records to get approval. Interacts effectively in carrying out these responsibilities, presenting a positive image for the Division of Thoracic and Foregut Surgery. Works regularly with URMC patient registration and clinical information systems.

Document and Information Management (10%)

• Documents telephone encounters in eRecord, completion/submission of patient care and insurance documents. Coordinates maintenance of patient records, documentation for billing, and completion/submission of documents regarding patient care and insurance. Transcribes proofreads and ensures accuracy and timeliness of all written materials, including medical reports and correspondences. Demonstrates knowledge of medical terminology, word processing, spreadsheets, and presentation software. Researches hospital medical records for the information requested by physicians, insurance companies, and attorneys. Occasionally composes, takes minutes, types, and signs nonroutine correspondence providing factual information.

Time and Calendar Management (5%)

• Functions as one of the points of contact for the surgeons and APP's of the Thoracic and Foregut Division of Surgery. Effectively balances competing demands of surgeon time by managing calendar, including all clinical activity, administrative meetings, research, education and academic commitments.

Other Office Management (5%)

Assists in managing all incoming mail for surgeon(s) and nurse practitioner(s), assuring that all correspondence receives timely attention and is followed up appropriately. Assists with training incoming new secretaries or temporary secretaries when requested. Functional knowledge of various office equipment. Provides coverage for absences within the division, off-site practice location if needed, and within the department when requested.

Other duties as assigned

MINIMUM EDUCATION & EXPERIENCE

• High School diploma or equivalent and 2 years of relevant experience required
• Associate's degree in Medical, Secretarial, billing, or related field preferred.
• Or equivalent combination of education and experience
• Medical Terminology, experience with surgical/appointment scheduling software and electronic medical records preferred

KNOWLEDGE, SKILLS AND ABILITIES

• Demonstrated customer relations skills required

• Medical Terminology, experiences with surgical/appointment scheduling software, and electronic medical records preferred.

• Excellent interpersonal skills, customer service skills, and organizational skills preferred.

• Strong attention to detail and communication skills, including written communication preferred.

• Working knowledge of word processing and spreadsheet applications preferred.

• Experience in medical office setting preferred.

• eRecord, Cadence, and medical terminology preferred.

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