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Prior Auth Coordinator

Company: Wilson Medical Center
Location: Wilson
Posted on: May 15, 2024

Job Description:

Who We Are:People are our passion and purpose. Work where you are appreciated for who you are not just what you can do. At Wilson Medical Center, a 294-bed facility, we bring new and innovative programs to those who matter the most - our community. With great pride, we offer Growing Tree Child Care Center on-site daycare where children are offered a nurturing, safe environment centered around the needs of each child. Where We Are:Wilson residents enjoy a community rich in educational, cultural, and social opportunities. We are home to numerous athletic and water sports, festivals, and arts and entertainment venues. From the beach to the mountains, in Wilson, you are within easy driving distance of all that North Carolina has to offer. Why Choose Us: - - - - - Health (Medical, Dental, Vision) and 401K Benefits for full-time employees - - - - - Competitive Paid Time Off / Extended Illness Bank package for full-time employees - - - - - Employee Assistance Program - mental, physical, and financial wellness assistance - - - - - Tuition Reimbursement/Assistance for qualified applicants - - - - - Opportunities for education and training through a partnership with Duke LifePoint Healthcare - - - - - Growing Tree On-Site Childcare Facility - - - - - And much more---Position Summary:The Prior Authorization Coordinator is an essential part of a multi-disciplinary team that provides high-quality patient care. The Prior Authorization Coordinator processes all inbound prior authorizations for the department. Prior Authorization Coordinator will coordinate and ensure the smooth flow of the authorization process to meet the needs of our patients, community specialists, and physicians to represent a professional and positive experience. This candidate will review chart documentation to ensure the patient meets medical policy guidelines, prioritize incoming authorization requests according to urgency, obtain authorization via the payer website or by phone, follow up regularly on pending cases, initiate appeals for denied authorizations, and respond to clinic questions regarding payer medical policy guidelines. Candidates will also confirm the accuracy of CPT and ICD-10 diagnoses in the procedure order as well as maintain individual payer files to include up-to-date requirements needed to successfully obtain authorizations. The candidate must be at ease interacting with patients, physicians, and insurance companies to create relationships that will promote a pleasant and caring practice. This role also includes ensuring that other positions within the practice are being covered and providing a smooth and positive atmosphere for patients, physicians, and fellow workers.ESSENTIAL FUNCTIONS Responsible for patient and insurance verification using automated eligibility verification systems Communicate with appropriate parties to obtain medical referrals/authorizations and ensure patient and insurance financial obligations are validated and met prior to patient's visit Develop relationships with other Dr. Offices, maintain and foster network of contacts for promoting practice services Use Electronic Medical Records for scheduling/maintaining patient records and appointments Ability to do medical assistant and/or front desk responsibilities when needed (training would be provided) Other duties may be assigned if determined in the best interest of the Practice Compliance, HIPAA, and Security Employees acknowledge that compliance with CarePoint's HIPAA, Security, and Compliance Plan policies and procedures as well as all other CarePoint policies and procedures is a condition of employment and that any violation will result in sanctions up to and including termination based on the type and severity of the violation. Access to and use of Protected Health Information - security clearance that allows employees to review, investigate, and respond to questions from payors. EEOC Statement:Wilson Medical Center is committed to providing Equal Employment Opportunities for all applicants, and employees while complying with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans' status or any other basis protected by applicable federal, state or local law.Minimum QualificationsJOB REQUIREMENTS Minimum education: High School DiplomaMinimum Work Experience Minimum 1-2 years of healthcare experience. -Minimum 1-2 years of Medical Office experience. Work experience in radiation oncology practice is preferred. -Required Skills: Critical thinking skills, decisive judgment and the ability to work with minimal supervision.Equal opportunity and affirmative action employers and are looking for diversity in candidates for employment: Minority/Female/Disabled/Protected Veteran

Keywords: Wilson Medical Center, Wilson , Prior Auth Coordinator, Other , Wilson, North Carolina

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