AUTHORIZATION CLERK

Job Locations

US-CA

Overview

Tri-City Healthcare District has been serving the North County region for almost 60 years and remains committed to providing high quality healthcare and community services for every individual we encounter regardless of race, color, ethnicity, gender, sexual orientation, disability or socioeconomic status.

Our mission is to advance the health and wellness of the community we serve. In order to achieve our mission, we see, hear and listen to our front line healthcare workers, employees, medical staff and all community stakeholders in order to understand and meet our community's needs.

Position Summary:

The Authorization Clerk maintains the highest standards of customer service excellence. Responsible for a variety of duties including: registration, scheduling, exam order entry, record integrity, obtaining insurance authorization and referrals.

Major Position Responsibilities:

The position characteristics reflect the most important duties, responsibilities and competencies considered necessary to perform the essential functions of the job in a fully competent manner. They should not be considered as a detailed description of all the work requirements of the position. The characteristics of the position and standards of performance may be changed by TCMC with or without prior notice based on the needs of the organization.

• Maintains a safe, clean working environment, including unit based safety and infection control requirements.
• Responsible for verifying insurance coverage, eligibility, benefits, obtaining authorizations and pre-certs as required by the individual insurance company.
• Obtains prior authorization for medication not on patients insurance formulary as requested by MD or MA, completes prior authorization transaction and notifies requesting MD or MA of any issues.
• Processes all information required to complete referrals prioritizing by level of urgency and patient need.
• Accurately enter notes regarding letters or correspondence from insurance companies regarding insurance authorization or other notifications.
• Adheres to all medical practice policies and procedures.
• Inform patients of referral status.
• Answers telephone inquiries on status of referral.
• Performs other duties as necessary.

Qualifications:

• Minimum 3-5 years Authorization Clerk experience in a hospital or medical office, required.
• Ability to effectively present information in one-on-one and small group situations to patients, clients, and other employees of the organization.
• Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
• Must be able to interact and communicate with all levels of staff, physicians, patients and families in an effective manner.
• Demonstrated knowledge of computer technology, including word processing, spreadsheet, and database.
• Ability to work under stress and deal effectively and courteously with difficult people.
• Ability to relate and work with people of all authority levels, ages, social and ethnic backgrounds.
• Knowledge of medical procedure, as they apply to insurance authorizations.

Education:

• High School diploma or GED, required.

Each new hire candidate who is offered employment must pass a physical evaluation, urine drug screen and pre-employment background checks before starting work.

TCHD is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, sexual orientation, or gender identity/expression), age, marital status, status as a protected veteran, among other things, or status as a qualified individual with a disability.