Patient Access Authorization Specialist (PRN)
Blanchard Valley Regional Health Center

PURPOSE OF THIS POSITION

The primary purpose of this position is to plan and coordinate the authorization functions for BVHS patients. Act as a liaison between the physicians, facilities, patients and professional billing companies. Coordinates information between patients, their insurance companies, and the facilities at which the patient is being served. Responsible for accurately entering patient data and interpreting insurance verification and coverage for patients.

JOB DUTIES/RESPONSIBILITIES

• Duty 1: Ability to process patient authorizations in a timely manner with accurate data.
• Duty 2: Ability to use current EHR system and all insurance verification and authorization tools, identifies and confirms active insurance coverage and required authorizations for outpatient and inpatient services. Ability to discover/provide clinical data in the EHR or from the ordering provider to support authorization needs.
• Duty 3: Ability to effectively communicate with insurance and governmental agencies in order to have complete and accurate procedure authorizations and approvals.
• Duty 4: Ability to professionally communicate to all patients and office staff, and meet age specific requirements for handling their requests.
• Duty 5: Continue to stay informed of any statute and/or regulation that could affect Authorization requirements.
• Duty 6: Work through the retro auth request lists, working with denials, and have the ability to timely address order/rad changes that may affect an authorization.
• Duty 7: Acts as a liaison between the facility, patient/family and ordering provider to resolve problems and/or address complaints.
• Duty 8: Participates in a variety of unit and hospital educational programs to maintain current skills and competency levels. Participates in and fully supports new hire and other department training and shadowing. Provides a positive learning environment and compassionate mentoring.
• Duty 9: Has ability to problem solve and offers assistance as needed to all customer groups.
• Duty 10: Performs all duties and responsibilities in a manner consistent with and supportive of the mission and value statement of Blanchard Valley Health System.

REQUIRED QUALIFICATIONS

• High school graduate or GED equivalent
• Data entry and/or PC experience required
• Medical terminology coursework or knowledge required
• BWC, VA, Medicare, Medicaid and commercial healthcare insurance knowledge
• Positive service-oriented interpersonal and communication skills required
• Individual must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patient served on his/her assigned unit/department. The individual must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient status. Must be able to interpret the appropriate information needed to identify each patient's requirements relative to their age-specific needs and to provide the care needed as described in the area's policies and procedures

PREFERRED QUALIFICATIONS

• Some related college preferred
• Insurance verification and authorization submission/verification experience preferred
• Knowledge of current EHR and insurance verification/authorization software
• Ability to meet remote work requirements

PHYSICAL DEMANDS

This position requires a full range of body motion with intermittent walking, lifting, bending, climbing, squatting, kneeling, twisting, sitting and standing. The associate must be able to lift 20-30 pounds or more. The individual must have excellent eye-hand coordination with the ability to grasp, push and pull, have fine fingers dexterity and manipulation. The associate must be able to reach work above the shoulders. This position requires corrected vision and hearing in the normal range. The associate must have excellent verbal skills to communicate with patients, physicians, and co-workers.

This position is classified "at risk" for possible occupational exposure to blood borne pathogens (HBV, HIV, etc.)

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