Prior Authorization Representative Jobs in Virginia

Pay Range

Patient Service Representative serves as the first point of contact for patients within the Valley Health physicians' network. This is a key role in the patient experience and must demonstrate excellence in all patient and customer encounters including face-to-face and telephone interactions. This position assures that a high-quality patient experience takes place by providing administrative support to the ambulatory care team through excellent customer service, attention to detail and interpersonal skills. This position is responsible for the accurate and appropriate scheduling of patients for optimum care and provider efficiency. This position is responsible for collecting accurate demographic and financial information during the scheduling and/or registration processes to ensure full and timely revenue capture.

Appointment Scheduling and Referral Functions

Listens to patients requests for an appointment and then schedules an outpatient appointment while following clinic scheduling guidelines. Offers alternate providers or locations when appropriate to meet the patients' needs. Raises up patients' needs that they cannot meet to Office Coordinator or Practice Manager.

Electronically selects and sends appropriate appointment reminder letter to the patient in accordance with clinic scheduling guidelines.

Utilizes all available scheduling functions, such as Wait Lists, to aid service to patients as appropriate.

Follow established clinic scheduling guidelines when cancelling and rescheduling appointments. Directs any requests from providers or other staff to adjust appointment schedules to Office Coordinator or Practice Manager for review and approval before acting.

Process urgent requests for referrals same day. Process routine referral requests within 72 hours.

Obtains prior approval or prior authorization as needed. Communicates referral appointment and appointment instructions to patient.

Performs Reception Functions

Receives and greets every patient in a courteous and friendly manner using a welcoming and positive tone, words and actions. Patients are serviced with the objective of meeting patient needs.

Ensures new patients are provided appropriate documents as determined by the practice.

Raises up emergent situations or expressed patient problems or concerns directly to Office Coordinator or Practice Manager for assistance.

Supports the care team with keeping patients informed about any delays in the delivery of care the patient might experience in the waiting room and exam room.

Performs Registration Functions

Obtains all information necessary to complete the outpatient registration process assuring demographic and financial/insurance information is correct and entered accurately into the Epic system.

Assures correct data capture and data entry necessary for regulatory agencies and compliance requirements.

Maintains required level of knowledge and proficiency in all core functions (demographic and financial information capture, insurance eligibility and verification, regulatory and compliance monitoring) of front desk operations.

Collection of Payments/Cash Handling

Conveys to patient what payment is due based upon Insurance card or insurance verification and requests of patient how they will be paying today (cash, check, credit card).

Receive and receipt all payments accurately as determined by daily cash verification process.

Maintain and balance cash drawer accurately as determined by daily cash up process.

Telephone Functions

Answers phones within 3 rings using a 3-part greeting (Name of clinic, your name, "How may I help you?").

Ends calls courteously by asking patient if there is anything else we can for them today.

Takes clear, complete and accurate phone messages or prescription requests using the Epic messaging system.

Health Information Management Functions

Date stamps all incoming patient related information and delivers to appropriate provider or staff person for action on a daily basis.

Prepares accurately all correspondence to patients and/or other entities as directed by providers or other staff person.

Sends requests for routine or subpoenaed medical record releases to assigned HIM location for processing. Handles same day requests for medical records for patient care continuity as needed. Seeks assistance from HIM resources with any questions related to medical records release process.

Receives, process and distributes incoming mail in a timely manner and in accordance with established clinic processes.

Patient Health Information is accessed to perform job responsibilities and for no other reason. Patient information is kept confidential and discussed on a need-to-know basis only.

Cross Coverage/Office Support Functions

Covers at other locations performing like office functions as requested in times of staffing shortages or during workload efficiency adjustments.

Maintains sufficient office supplies and required forms for daily front desk operations.

Maintains departmental filing system accurately. Classifies, sorts, distributes and/or files correspondence, articles, mail, records and other documents.

Opens and/or closes clinic according to practice guidelines

Performs Similar or Related Duties as Requested or Directed

Education

High School Diploma or equivalent is required.

Associates degree is preferred.

Experience

(1) year of relevant work experience is required.

Associate's degree may substitute for one year of relevant work experience.

Qualifications

Customer service experience preferred.

Strong computer, customer service and communication skills required.

Ability to prioritize work.

Ability to handle confidential information and sensitive situations required.

Interpersonal skills to work with diverse people within and outside organization required.

At Valley Health, we believe everyone is a caregiver, and our goal is to create an environment where our caregivers thrive physically, financially, and emotionally. In addition to a competitive salary, our most popular benefits for full-time employees include:

• A Zero-Deductible Health Plan
• Dental and vision insurance
• Generous Paid Time Off
• Tuition Assistance
• Retirement Savings Match
• A Robust Employee Assistance Program to help with many aspects of emotional wellbeing
• Membership to Healthy U: An Incentive-Based Wellness Program

Valley Health also offers a health savings account & flexible spending account for childcare, life insurance, short-term and long-term disability, and professional development. In addition, several perks come with working for the largest employer in the region, such as discounts to on-campus dining, and more.

To see the full scale of what we offer, visit valleyhealthbenefits.com.