Top Prior Authorization Companies Jobs in Riverside, CA

Overview
Under general supervision, the position is responsible for registering Inpatients, Outpatients, and Ancillary patients in the ER. While compiling complete and accurate information for hospital records and timely reimbursement. Maintains effective patient flow and completes the admitting process in a timely manner to assist in prompt treatment of the patient. Maintains effective working relations with coworkers, nurses, physicians and other hospital staff members in order to insure workflow effectiveness. Greets and assists all customers and visitors, whether in person or by telephone, using guest relation techniques while professionally representing the visions and values of AHMC- ARMC.
This position requires the full understanding and active participation in fulfilling the mission of AHMC-Anaheim Regional Medical Center. It is expected that the employee demonstrate behavior consistent with the core values of AHMCARMC. The employee shall support AHMC- Anaheim Regional Medical Center's strategic plan and goals and direction of the performance improvement plan. The employee will also be expected to support all organizational expectations including, but not limited to; Customer Service, Patient's Rights, Confidentiality of Information, Environment of Care and AHMC-ARMC initiatives.
Responsibilities
A.Consistently applies infection control policies/practices.
1. Understands and practices standard precautions for self and others in patient care activities.
2. Understands and practices appropriate disease-specific isolation.
3. Appropriately handles and disposes of sharps (i.e., needles, etc.) as required.
4. Ensures sterility of supplies and equipment.
B. Meets population/age specific competencies per unit specific addendum.
C. Attends department specific education/training, inservices, and staff meetings.
1. Attends mandatory inservices/educational/training activities.
2. Submits all required paperwork on time.
3. Verifies, by signature/initials, attendance at staff meetings or reading of staff meeting minutes.
D. Participates in department specific performance improvement project.
1. Actively assists in unit performance improvement monitoring.
2. Knows and understands PDSA Model for Performance Improvement Program.
3. Demonstrates understanding of performance improvement principles in job performance.
E. Registers fnpatierits, Outpatients, ER, and Ancillary patients compiling complete and accurate information for hospital records and timely reimbursement.
1. Interviews patients to obtain demographic data using alternate sources of information when necessary such as family members, transferring facilities, physician's office and/or nursing homes. Obtains all signatures as required.
2. Accurately enters and updates patient information via computer using proper registration procedures.
3. Ensures that all insurance information is obtained and verified utilizing available systems. Notifies Insurance Verifier of any potential insurance issues or benefit issues. Secures accounts by properly identifying procedures requiring prior authorization, insuring it has been obtained.
4. Demonstrates a working knowledge of third party payors requirements necessary to support optimum fiscal reimbursement. Ensures financial classes and insurance codes are identified and properly entered.
5. Informs customers of their financial responsibility and patient liability amounts are collected, i.e., deposits, co-pays, share of cost, deductibles, etc.
6. Prioritizes and coordinates essential job functions.
7. Completes and documents all applicable registration forms.
8. Obtains eligibility, PCP, and insurance information through available systems and web based insurance companies.
9. ER specific: complies with all EMTALNCOBRA ER requirements.
F. Collects the patient's responsibility to include; co-pays, deductibles, and co-insurance, when applicable.
1. Obtains insurance co-pay amounts from insurance verification and notifies patient.
2. Uses alternative methods when standard procedures do not provide the required information.
3. Follows-up on all registrations when information is required to insure prompt reimbursement.
G. Maintains effective patient flow and completes the admitting process in a timely manner to assist in prompt treatment of the patient.
1. Introduces him/herself and explains registration process to patient. Speaks in a moderate tone and never discusses patient's condition unless required by job related conversations.
2. Interaction with the customer and guests is professional and extraneous conversation is kept to a minimum to expedite the registration.
3. Follows hospital and departmental guidelines and procedures. Responds and adapts to new procedures, processes, and memos. Adapts easily to fluctuating volumes of registrations.
4. Shares an overall equal percentage of registration volume and completes the registration process within established departmental standards of accuracy.
H. Utilizes customer service skills with patients and maintains effective working relations with coworkers, nurses, physicians, and other hospital staff members in order to ensure work flow effectiveness.
1. Answers the telephone within three rings in a respectful and pleasant manner. Asks open-ended questions to discover facts and remains calm and polite regardless of circumstances.
2. Receives and greets all customers and family members in a courteous and professional manner, using guest relation techniques and confidentiality standards.
3. Effectively handles upset or potentially distressed customers or patients.
I. Complies with Hospital's Attendance and Timekeeping policies.
J. Must pass chart audit with minimum errors of 95% or better.
Qualifications
• Ability to effectively communicate.
• Effective customer service and interpersonal skills.
• Computer skills and typing skills required.
• Medical terminology preferred.
• General knowledge of third party payors including minimum of 1-2 years Admitting/Registration or equivalent healthcare experience preferred.
• Bilingual (English/Spanish) preferred (as applicable).