Prior Auth Jobs in Florida (NOW HIRING)

Description:
Scheduling Responsibilities
Responsible for staffing the case: Determine which clinician will start and follow the case (geographic, discipline, etc...) and contact them to confirm assignment.
Communicate patient changes in status to all treating clinicians and adjust schedule(s) accordingly
Enter visits (frequencies) into Axxess, including supervisory visits.
Enter initial authorization and subsequent authorizations into Axxess
Follow-up with therapists to obtain frequencies for re-evaluations that have not been called into the office within 48 hrs.
Contact clinicians regarding prior week's schedules to verify & follow up regarding;
• Open visits
• Verify with clinicians if there were any missed visits
• Verify if SOC / RC or DC occurred
• Update Scheduling Board
• Change patient status if needed
Intake Responsibilities
Receive initial referrals:
• Check with Administrator prior to rejecting
• Review referral data with Clinical Manager to determine clinical needs.
• Enter new referral(s) into Axxess, including initial referral order, authorization information, etc.
Contacts referral source to review and obtain all pertinent information required to process the referral, including initial order;
• Identify the PCP (last OV)
• OVN/H&P
• DC summary
Follow up on all electronic referral sources (Allscripts / Careport)
Contact clinicians to verify acceptance of new patient assignments
Contacts other providers (DME, Pharmacy) to coordinate overall care for the patient.
Scan initial patient information into Axxess and Dropbox;
• Referral Info
• F2F
• Referral Order
• Mecca Check / Authorizations
Maintain pending file of any referrals for which services have been delayed.
Responsible for monitoring authorizations for VA/Managed Care
• Communicate patients in need of authorizations for additional visits or extended authorization dates
• Track scheduled visits that are not authorized
• Update new auths in Axxess and Review authorizations (auths) weekly and identify expired or soon to be expired auths
• Communicate patients in need of authorizations for additional visits or extended authorization dates
• Track scheduled visits that are not authorized
• Update new auths in Axxess and scan in documents to Axxess and Dropbox
• Notify clinicians about Re-Evals that need to be closed in order to provide documentation to payor
• Prepare auth request email & send to payor requesting additional auth
Request HHA services from FLHC for any patients needing HHA servces:
• Prepare form called "Seaside HH form requesting FLHC services" and send to FLHC remote admin personnel.
• Follow-up with FLHC staff to clarify and determine Aide schedule
• Notify patient once schedule is confirmed
Records Management Responsibilities
Create, maintain and update new patient charts in dropbox.
Track Documents (i.e. F2F, OVN's, H&P's, DC Summaries) that are not initially received and require follow up.
Run discharge report each week and process NOMNC (48 hrs prior to DC).
Responsible for sending, tracking and obtaining orders;
• Sending out documentation (i.e. 485, VO, F2F) to MD each week. Note: Another individual saves the orders as a pdf file in dropbox
• Rename and Save Received Documents into Dropbox, then mark orders as received in Axxess. Note: Another individual saves the documents into Axxess (against the task)
• Follow up on outstanding orders over 21 days old.
• Clear out F2F documents and Transfer Summaries from Orders to be sent and mark as received
• Send out Discharge Summaries from Orders to be sent and mark as received
Administrative / Other Duties
Answer the telephone promptly, direct all calls appropriately, and take accurate messages.
Print / Create SOC Packets to maintain at least 10 packets for Palm Beach and 5 for Broward.
Check e-fax (Consensus) regularly:
• Check for signed orders; save to appropriate Dropbox and Axxess locations
• Mark orders as received signed and indicate MD signature date
• Process / Triage Consensus Documents
•
Fax Transfer Summary reports to receiving facilities
Place orders of all forms, office supplies, including toner and paper
Contact patients one week after the SOC to perform a customer satisfaction survey call.
Perform other assignments as requested.